Provider Demographics
NPI:1750191250
Name:MENCHA, MEKLIT
Entity type:Individual
Prefix:
First Name:MEKLIT
Middle Name:
Last Name:MENCHA
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 1:15718 53RD PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4739
Mailing Address - Country:US
Mailing Address - Phone:425-563-4139
Mailing Address - Fax:425-740-0233
Practice Address - Street 1:15718 53RD PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4739
Practice Address - Country:US
Practice Address - Phone:425-563-4139
Practice Address - Fax:425-740-0233
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61582058164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse