Provider Demographics
NPI:1821874058
Name:HAILE, MEKLIT K
Entity Type:Individual
Prefix:
First Name:MEKLIT
Middle Name:K
Last Name:HAILE
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 1:6018 CADY RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-3724
Mailing Address - Country:US
Mailing Address - Phone:206-428-8602
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6212
Practice Address - Country:US
Practice Address - Phone:425-374-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.61252916253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care