Provider Demographics
NPI:1578260592
Name:DESSIE, HIRUT
Entity Type:Individual
Prefix:
First Name:HIRUT
Middle Name:
Last Name:DESSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19037 104TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2924
Mailing Address - Country:US
Mailing Address - Phone:206-476-6539
Mailing Address - Fax:425-892-8607
Practice Address - Street 1:19037 104TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2924
Practice Address - Country:US
Practice Address - Phone:206-476-6539
Practice Address - Fax:425-892-8607
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60965506163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse