Provider Demographics
NPI:1841822384
Name:TAFERE, MANTEGBOSH ABEBE (CNA)
Entity type:Individual
Prefix:MISS
First Name:MANTEGBOSH
Middle Name:ABEBE
Last Name:TAFERE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2006
Mailing Address - Country:US
Mailing Address - Phone:206-335-3454
Mailing Address - Fax:
Practice Address - Street 1:15050 29TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-2006
Practice Address - Country:US
Practice Address - Phone:206-335-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health