Provider Demographics
NPI:1083259451
Name:BASSAW, MAAME
Entity Type:Individual
Prefix:
First Name:MAAME
Middle Name:
Last Name:BASSAW
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 1:1392 BURNSIDE PL
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8811
Mailing Address - Country:US
Mailing Address - Phone:253-343-4716
Mailing Address - Fax:
Practice Address - Street 1:1392 BURNSIDE PL
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8811
Practice Address - Country:US
Practice Address - Phone:253-343-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider