Provider Demographics
NPI:1558310755
Name:MELAKU, HABTAMUA (DNP, MSN, FNP, ARNP)
Entity Type:Individual
Prefix:
First Name:HABTAMUA
Middle Name:
Last Name:MELAKU
Suffix:
Gender:F
Credentials:DNP, MSN, FNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:546 N JEFFERSON LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-624-0111
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00114991363L00000X
WAAP30004850363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA147661OtherL & I
WA9626581Medicaid
WA9626581Medicaid
WA9626581Medicaid