Individual
FADUMO ISMAEL OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-C
Contact information
Practice address
1701 18TH AVE S, SEATTLE, WA 98144-4317
(253) 833-7444
Mailing address
325 W GOWE ST, KENT, WA 98032-5892
(253) 833-7444
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60850885
WA
363LF0000X
Family Nurse Practitioner
AP60850885
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60850885
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP60850885
WA DEPARTMENT OF HEALTH
WA
Enumeration date
05/29/2018
Last updated
06/28/2022
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