Provider Demographics
NPI:1023652153
Name:KASSAYE, ELSA T (RN)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:T
Last Name:KASSAYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 148TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2169
Mailing Address - Country:US
Mailing Address - Phone:206-852-6845
Mailing Address - Fax:
Practice Address - Street 1:101 148TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-2169
Practice Address - Country:US
Practice Address - Phone:206-852-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00140258163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse