Provider Demographics
NPI:1003506452
Name:ASNAKE, TEGBAR ADDISU
Entity Type:Individual
Prefix:
First Name:TEGBAR
Middle Name:ADDISU
Last Name:ASNAKE
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 1:15917 55TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4747
Mailing Address - Country:US
Mailing Address - Phone:425-246-0207
Mailing Address - Fax:
Practice Address - Street 1:15917 55TH PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4747
Practice Address - Country:US
Practice Address - Phone:425-246-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174329163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse