Provider Demographics
NPI:1043778376
Name:FATAJO, EBRIMA S (DNP)
Entity Type:Individual
Prefix:
First Name:EBRIMA
Middle Name:S
Last Name:FATAJO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 NE 135TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3192
Mailing Address - Country:US
Mailing Address - Phone:425-773-1881
Mailing Address - Fax:
Practice Address - Street 1:4515 MARTIN LUTHER KING JR WAY S STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2183
Practice Address - Country:US
Practice Address - Phone:425-773-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60869727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner