Provider Demographics
NPI:1306662598
Name:ASFAW, EPHREM MESFIN
Entity type:Individual
Prefix:
First Name:EPHREM
Middle Name:MESFIN
Last Name:ASFAW
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 1:1023 KENTISH RD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4932
Mailing Address - Country:US
Mailing Address - Phone:206-458-3158
Mailing Address - Fax:
Practice Address - Street 1:1023 KENTISH RD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4932
Practice Address - Country:US
Practice Address - Phone:206-458-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60001594163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse