Provider Demographics
NPI:1588228829
Name:TSEGAYE, SHEVONNE COLETTE CALKINS
Entity Type:Individual
Prefix:
First Name:SHEVONNE
Middle Name:COLETTE CALKINS
Last Name:TSEGAYE
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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-0014
Mailing Address - Country:US
Mailing Address - Phone:253-304-0151
Mailing Address - Fax:
Practice Address - Street 1:10125 NE 125TH DR APT 6
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9037
Practice Address - Country:US
Practice Address - Phone:253-304-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604238413374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula