Provider Demographics
NPI:1275865651
Name:FAROLE, FAISA ABUKAR (LICENSE MIDWIFE)
Entity Type:Individual
Prefix:
First Name:FAISA
Middle Name:ABUKAR
Last Name:FAROLE
Suffix:
Gender:F
Credentials:LICENSE MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SOUTHCENTER BLVD APT B18
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2288
Mailing Address - Country:US
Mailing Address - Phone:206-683-8167
Mailing Address - Fax:425-207-3025
Practice Address - Street 1:4015 SOUTHCENTER BLVD APT B18
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2288
Practice Address - Country:US
Practice Address - Phone:206-683-8167
Practice Address - Fax:425-207-3025
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7408917174H00000X
WA60623982176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2059612Medicaid
WA7408917Medicaid