Healthcare Provider Details

I. General information

NPI: 1992625735
Provider Name (Legal Business Name): ASILI INSTITUTE FOR WOMEN'S BRAIN HEALTH, TRAUMA & RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 B ST
SANTA ROSA CA
95401-5240
US

IV. Provider business mailing address

PO BOX 11643
SANTA ROSA CA
95406-1643
US

V. Phone/Fax

Practice location:
  • Phone: 916-842-8310
  • Fax:
Mailing address:
  • Phone: 916-842-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SELAMAWIT T GEBREZGHI
Title or Position: CEO/FOUNDER
Credential: FNP-C, PMHNP-BC
Phone: 916-842-8310