Provider Demographics
NPI:1881143774
Name:KIFLE, MELAKE ZERRAY
Entity type:Individual
Prefix:
First Name:MELAKE
Middle Name:ZERRAY
Last Name:KIFLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 S 180TH ST APT D7
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-4309
Mailing Address - Country:US
Mailing Address - Phone:206-327-5139
Mailing Address - Fax:
Practice Address - Street 1:15675 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2523
Practice Address - Country:US
Practice Address - Phone:206-631-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60600766164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse