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General NPI Number Information
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NPI Number | 1346715307
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Entity Type | Individual
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Provider Name | BIRHANU Z. ADMASSIE FNP
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Gender | Male
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 2122 W KETTLEMAN LN
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City | LODI
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State | CA
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Zip | 95242
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Country | US
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Telephone | 209-224-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 4059 LOST CANYON COURT, HOUSE
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City | ANTIOCH
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State | CA
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Zip | 94531
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Country | US
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Telephone | 925-779-1982
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95009185
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License Number State | CA
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