MEDICARE: ERZIK A EBRAHIM

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	163W00000X	Registered Nurse	RN61587671	WA

General Provider Information

NPI Number	:	1871454231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERZIK A EBRAHIM

Provider Business Mailing Address
First Line	:	5811 RAINIER AVE S STE 111
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2705
Country	:	US
Telephone Number	:	206-383-5539
Fax Number	:	206-260-2741

Provider Business Practice Location Address
First Line	:	5811 RAINIER AVE S STE 111
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2705
Country	:	US
Telephone Number	:	206-383-5539
Fax Number	:	206-260-2741

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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