Provider Demographics
NPI:1346984465
Name:BOT, IMAN WARSAME (PROVIDER RN)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:WARSAME
Last Name:BOT
Suffix:
Gender:F
Credentials:PROVIDER RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-3785
Mailing Address - Country:US
Mailing Address - Phone:425-458-4767
Mailing Address - Fax:425-678-8391
Practice Address - Street 1:7328 202ND ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5820
Practice Address - Country:US
Practice Address - Phone:425-640-3758
Practice Address - Fax:425-678-8391
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60028954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse