Healthcare Provider Details

I. General information

NPI: 1336830439
Provider Name (Legal Business Name): HELEN EYOB GEBREWOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11709 37TH DR SE
EVERETT WA
98208-5302
US

IV. Provider business mailing address

11709 37TH DR SE
EVERETT WA
98208-5302
US

V. Phone/Fax

Practice location:
  • Phone: 425-338-2099
  • Fax: 425-948-7034
Mailing address:
  • Phone: 425-338-2099
  • Fax: 425-948-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10092058
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: