Provider Demographics
NPI:1508604554
Name:FALLAHI, ZAHRA AZITA (RN)
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:AZITA
Last Name:FALLAHI
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 1:3510 STEELHAMMER DR
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1532
Mailing Address - Country:US
Mailing Address - Phone:360-623-8020
Mailing Address - Fax:360-623-8521
Practice Address - Street 1:3510 STEELHAMMER DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1532
Practice Address - Country:US
Practice Address - Phone:360-623-8020
Practice Address - Fax:360-623-8521
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA60777652163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health