Healthcare Provider Details

I. General information

NPI: 1366237521
Provider Name (Legal Business Name): MEBRAHTU HABTEZGI GEBREKIDAN CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8349 39TH AVE S
SEATTLE WA
98118-4317
US

IV. Provider business mailing address

8349 39TH AVE S
SEATTLE WA
98118-4317
US

V. Phone/Fax

Practice location:
  • Phone: 206-229-1808
  • Fax:
Mailing address:
  • Phone: 206-229-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number757102
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: