Provider Demographics
NPI:1811686694
Name:KASSA, KEWSER G (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KEWSER
Middle Name:G
Last Name:KASSA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20024 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2002
Mailing Address - Country:US
Mailing Address - Phone:206-832-6086
Mailing Address - Fax:
Practice Address - Street 1:2101 E YESLER WAY STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5900
Practice Address - Country:US
Practice Address - Phone:206-299-1900
Practice Address - Fax:206-290-1997
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61384226163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health