Healthcare Provider Details

I. General information

NPI: 1578493615
Provider Name (Legal Business Name): SELAMAWIT DEMISSIE GEBREGIORGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S HALEYVILLE ST
AURORA CO
80016-4472
US

IV. Provider business mailing address

5600 S HALEYVILLE ST
AURORA CO
80016-4472
US

V. Phone/Fax

Practice location:
  • Phone: 720-882-3345
  • Fax: 720-222-5791
Mailing address:
  • Phone: 720-882-3345
  • Fax: 720-222-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.00466494
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: