Provider Demographics
NPI:1235976630
Name:NORAHUN, TESFAYE B
Entity type:Individual
Prefix:
First Name:TESFAYE
Middle Name:B
Last Name:NORAHUN
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 1:18903 129TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3103
Mailing Address - Country:US
Mailing Address - Phone:206-349-2285
Mailing Address - Fax:
Practice Address - Street 1:12710 20TH PL W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5583
Practice Address - Country:US
Practice Address - Phone:206-349-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755473376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide