Provider Demographics
NPI:1801782180
Name:MEKONNEN, MELAT
Entity type:Individual
Prefix:
First Name:MELAT
Middle Name:
Last Name:MEKONNEN
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 1:24924 13TH PL S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8574
Mailing Address - Country:US
Mailing Address - Phone:206-859-8399
Mailing Address - Fax:
Practice Address - Street 1:24924 13TH PL S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-8574
Practice Address - Country:US
Practice Address - Phone:206-859-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60739318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse