Provider Demographics
NPI:1003407495
Name:FESSEHA, MEHERET KIFLE
Entity Type:Individual
Prefix:
First Name:MEHERET
Middle Name:KIFLE
Last Name:FESSEHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3024
Mailing Address - Country:US
Mailing Address - Phone:206-427-6456
Mailing Address - Fax:
Practice Address - Street 1:117 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3024
Practice Address - Country:US
Practice Address - Phone:206-427-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00135805163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse