Provider Demographics
NPI:1518763812
Name:BEYENE, MASRESHA M
Entity type:Individual
Prefix:
First Name:MASRESHA
Middle Name:M
Last Name:BEYENE
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 1:32428 50TH CT SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-1918
Mailing Address - Country:US
Mailing Address - Phone:206-430-8706
Mailing Address - Fax:
Practice Address - Street 1:32428 50TH CT SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-1918
Practice Address - Country:US
Practice Address - Phone:206-430-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61074537163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health