Provider Demographics
NPI:1982381802
Name:HAILE, ABEBANESH TADESSE
Entity Type:Individual
Prefix:
First Name:ABEBANESH
Middle Name:TADESSE
Last Name:HAILE
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 1:15502 26TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087
Mailing Address - Country:US
Mailing Address - Phone:425-737-3678
Mailing Address - Fax:425-582-2268
Practice Address - Street 1:15502 26TH PL W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087
Practice Address - Country:US
Practice Address - Phone:425-737-3678
Practice Address - Fax:425-582-2268
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753688253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care