Provider Demographics
NPI:1639823321
Name:SHIFERAW, BETHLEHEM (RN)
Entity Type:Individual
Prefix:
First Name:BETHLEHEM
Middle Name:
Last Name:SHIFERAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 164TH ST SW APT P203
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8603
Mailing Address - Country:US
Mailing Address - Phone:206-482-1192
Mailing Address - Fax:
Practice Address - Street 1:4525 164TH ST SW APT P203
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8603
Practice Address - Country:US
Practice Address - Phone:206-482-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60763474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty