Provider Demographics
NPI:1013366566
Name:MULATU, ALEMU (163W00000X)
Entity Type:Individual
Prefix:
First Name:ALEMU
Middle Name:
Last Name:MULATU
Suffix:
Gender:M
Credentials:163W00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20409 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8616
Mailing Address - Country:US
Mailing Address - Phone:206-428-8079
Mailing Address - Fax:
Practice Address - Street 1:20409 CRAWFORD RD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8616
Practice Address - Country:US
Practice Address - Phone:206-428-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN603341521163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse