MEDICARE: HABTAMUA MELAKU DNP, MSN, FNP, ARNP

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
1	363L00000X	Nurse Practitioner	RN00114991	WA
2	363LF0000X	Family Nurse Practitioner	AP30004850	WA
3	363L00000X	Nurse Practitioner	AP30004850	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147661	OTHER	WA	L & I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558310755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HABTAMUA MELAKU DNP, MSN, FNP, ARNP

Provider Business Mailing Address
First Line	:	107 S DIVISION ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-1510
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 N JEFFERSON LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-7104
Country	:	US
Telephone Number	:	509-624-0111
Fax Number	:	509-227-7070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/18/2021

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