Provider Demographics
NPI:1710389846
Name:ADNEW, LAKEW
Entity Type:Individual
Prefix:
First Name:LAKEW
Middle Name:
Last Name:ADNEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22634 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6915
Mailing Address - Country:US
Mailing Address - Phone:206-235-8112
Mailing Address - Fax:206-653-7300
Practice Address - Street 1:22634 10TH AVE S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6915
Practice Address - Country:US
Practice Address - Phone:206-235-8112
Practice Address - Fax:206-653-7300
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60480672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health