Provider Demographics
NPI:1003542994
Name:COULIBALY, MOHAMED (RN)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:COULIBALY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 SW 327TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2650
Mailing Address - Country:US
Mailing Address - Phone:253-306-9296
Mailing Address - Fax:
Practice Address - Street 1:4038 SW 327TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2650
Practice Address - Country:US
Practice Address - Phone:253-306-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60037861163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse