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General NPI Number Information
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NPI Number | 1164302584
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Entity Type | Individual
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Provider Name | ADHANOM HABTESLASSIE ASGEDOM
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Gender | Male
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 2717 NEUSE BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-2840
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Country | US
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Telephone | 252-514-9888
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Fax | 252-514-2881
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Provider Business Mailing Address
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Address Line | 2717 NEUSE BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-2840
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Country | US
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Telephone | 252-514-9888
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Fax | 252-514-2881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5023342
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License Number State | NC
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