Provider Demographics
NPI:1376315994
Name:AYELE, AZANAW M
Entity Type:Individual
Prefix:
First Name:AZANAW
Middle Name:M
Last Name:AYELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 S 255TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-9747
Mailing Address - Country:US
Mailing Address - Phone:206-422-5585
Mailing Address - Fax:
Practice Address - Street 1:3423 S 255TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-9747
Practice Address - Country:US
Practice Address - Phone:206-212-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60692990376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide