Provider Demographics
NPI:1659660892
Name:FIAMO, NAWO KOFFI (ARNP)
Entity Type:Individual
Prefix:MR
First Name:NAWO
Middle Name:KOFFI
Last Name:FIAMO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 11TH AVE STE 44
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3269
Mailing Address - Country:US
Mailing Address - Phone:206-491-0123
Mailing Address - Fax:509-895-7344
Practice Address - Street 1:210 S 11TH AVE STE 44
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3269
Practice Address - Country:US
Practice Address - Phone:206-491-0123
Practice Address - Fax:509-895-7344
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60214610363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health