Provider Demographics
NPI:1851041768
Name:FATIMA, KANEEZ
Entity Type:Individual
Prefix:
First Name:KANEEZ
Middle Name:
Last Name:FATIMA
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 1:19129 84TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5903
Mailing Address - Country:US
Mailing Address - Phone:206-949-4553
Mailing Address - Fax:425-774-8581
Practice Address - Street 1:19129 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5903
Practice Address - Country:US
Practice Address - Phone:206-949-4553
Practice Address - Fax:425-774-8581
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602078260171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter