Provider Demographics
NPI:1053880872
Name:KHALEEL, NADIA ISMAEL (MI)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:ISMAEL
Last Name:KHALEEL
Suffix:
Gender:F
Credentials:MI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17120 SE 276TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4588
Mailing Address - Country:US
Mailing Address - Phone:206-751-6460
Mailing Address - Fax:
Practice Address - Street 1:17120 SE 276TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4588
Practice Address - Country:US
Practice Address - Phone:206-751-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604158036171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty