Provider Demographics
NPI:1679469803
Name:ADEMASU, AZZAR (RN)
Entity type:Individual
Prefix:
First Name:AZZAR
Middle Name:
Last Name:ADEMASU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15358 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7409
Mailing Address - Country:US
Mailing Address - Phone:206-694-9239
Mailing Address - Fax:
Practice Address - Street 1:2119 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2333
Practice Address - Country:US
Practice Address - Phone:206-374-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61562421163WP2201X, 163WC1500X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice