Healthcare Provider Details

I. General information

NPI: 1396523064
Provider Name (Legal Business Name): DAWIT SAHLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 W HEATHERBRAE DR
PHOENIX AZ
85015-4764
US

IV. Provider business mailing address

3283 S MILLER DR
CHANDLER AZ
85286-0178
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-2100
  • Fax: 602-535-3166
Mailing address:
  • Phone: 602-410-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN165963
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number301404
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: