Provider Demographics
NPI:1598532848
Name:MEKBIB, SOSSNA
Entity Type:Individual
Prefix:
First Name:SOSSNA
Middle Name:
Last Name:MEKBIB
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 1:8923 NE 104TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1439
Mailing Address - Country:US
Mailing Address - Phone:503-453-0227
Mailing Address - Fax:368-952-8081
Practice Address - Street 1:8923 NE 104TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-1439
Practice Address - Country:US
Practice Address - Phone:503-453-0227
Practice Address - Fax:360-952-8081
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604048302311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home