Provider Demographics
NPI:1558037473
Name:MOHAMUD, NASRA ABDULLAHI (RN, MSN)
Entity Type:Individual
Prefix:
First Name:NASRA
Middle Name:ABDULLAHI
Last Name:MOHAMUD
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:FADUMA
Other - Middle Name:MOHAMED
Other - Last Name:ABDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24452 109TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4932
Mailing Address - Country:US
Mailing Address - Phone:253-205-5780
Mailing Address - Fax:
Practice Address - Street 1:18611 39TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5007
Practice Address - Country:US
Practice Address - Phone:253-205-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61181841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN61181841Medicaid