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NPI Code Detail

MEDICARE: FADUMO ISMAEL OMAR ARNP-C

MEDICARE: FADUMO ISMAEL OMAR ARNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAP60850885WA
2363LF0000XFamily Nurse PractitionerAP60850885WA
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAP60850885WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP60850885OTHERWAWA DEPARTMENT OF HEALTH

General Provider Information

NPI Number : 1164913893
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADUMO ISMAEL OMAR ARNP-C
Provider Business Mailing Address
First Line : 325 W GOWE ST
Second Line :
City : KENT
State : WA
Zip : 98032-5892
Country : US
Telephone Number : 253-833-7444
Fax Number :
Provider Business Practice Location Address
First Line : 1701 18TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98144-4317
Country : US
Telephone Number : 253-833-7444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2018
Last Update Date : 06/28/2022

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Directions to “ FADUMO ISMAEL OMAR ARNP-C” Practice Location

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