Provider Demographics
NPI:1275357873
Name:MOUSSAVI FARIDANI, ROODABEH III (NP)
Entity type:Individual
Prefix:
First Name:ROODABEH
Middle Name:
Last Name:MOUSSAVI FARIDANI
Suffix:III
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 176TH CIR NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7218
Mailing Address - Country:US
Mailing Address - Phone:425-556-8100
Mailing Address - Fax:
Practice Address - Street 1:10901 176TH CIR NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7218
Practice Address - Country:US
Practice Address - Phone:425-556-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61626192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily