Provider Demographics
NPI:1790465086
Name:SIRAJ, MEDINA ADEM
Entity Type:Individual
Prefix:
First Name:MEDINA
Middle Name:ADEM
Last Name:SIRAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:ASEFA
Other - Last Name:HAILU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 S 99TH PL APT 57
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-5048
Mailing Address - Country:US
Mailing Address - Phone:619-892-2051
Mailing Address - Fax:
Practice Address - Street 1:1010 S 99TH PL APT 57
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-5048
Practice Address - Country:US
Practice Address - Phone:619-892-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61309503163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health