Healthcare Provider Details

I. General information

NPI: 1770447187
Provider Name (Legal Business Name): SOLOMON BERHE REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10546 MIDNIGHT GLEAM AVE
LAS VEGAS NV
89129-3322
US

IV. Provider business mailing address

10546 MIDNIGHT GLEAM AVE
LAS VEGAS NV
89129-3322
US

V. Phone/Fax

Practice location:
  • Phone: 702-232-5743
  • Fax:
Mailing address:
  • Phone: 702-232-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number893556
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: