Provider Demographics
NPI:1730939430
Name:HABTTIE, LICHA
Entity type:Individual
Prefix:
First Name:LICHA
Middle Name:
Last Name:HABTTIE
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 1:14231 55TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3814
Mailing Address - Country:US
Mailing Address - Phone:206-335-0057
Mailing Address - Fax:425-678-8002
Practice Address - Street 1:14231 55TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3814
Practice Address - Country:US
Practice Address - Phone:206-335-0057
Practice Address - Fax:425-678-8002
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA756373374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide