Provider Demographics
NPI:1588354476
Name:NOOR, FADUMO
Entity type:Individual
Prefix:
First Name:FADUMO
Middle Name:
Last Name:NOOR
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 1:20052 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5739
Mailing Address - Country:US
Mailing Address - Phone:206-556-8101
Mailing Address - Fax:
Practice Address - Street 1:20052 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98198-5739
Practice Address - Country:US
Practice Address - Phone:206-556-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA0600X
WA0000000000000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care