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General NPI Number Information
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NPI Number | 1477201572
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Entity Type | Individual
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Provider Name | SAMRAWIT DEJENE MERSHA
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Gender | Female
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 3650 E 100TH CT
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City | THORNTON
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State | CO
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Zip | 80229-3550
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Country | US
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Telephone | 720-472-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 10120 S 20 MILE RD
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City | PARKER
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State | CO
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Zip | 80134-5666
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Country | US
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Telephone | 720-472-1366
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0998851
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License Number State | CO
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