MEDICARE: MARYAN ABDIRAHMAN

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	363AM0700X	Medical Physician Assistant	PA70055184	WA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1861254856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAN ABDIRAHMAN

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 LIMITED LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2704
Country	:	US
Telephone Number	:	360-491-1399
Fax Number	:	360-704-2914

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	12/19/2025

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Directions to “ MARYAN ABDIRAHMAN ” Practice Location

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