Provider Demographics
NPI:1689323248
Name:TECLEAB, RUT EYASU
Entity Type:Individual
Prefix:MISS
First Name:RUT
Middle Name:EYASU
Last Name:TECLEAB
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 1:3616 34TH AVE S UNIT 409
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5193
Mailing Address - Country:US
Mailing Address - Phone:206-637-6630
Mailing Address - Fax:
Practice Address - Street 1:3616 34TH AVE S UNIT 409
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5193
Practice Address - Country:US
Practice Address - Phone:206-637-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61238227376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide