MEDICARE: RAHEL GEBEYEHU MITIKU CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN.CNP.024880	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376195248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHEL GEBEYEHU MITIKU CNP

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:	419-520-2495
Fax Number	:	614-544-6370

Provider Business Practice Location Address
First Line	:	895 W 3RD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3106
Country	:	US
Telephone Number	:	614-437-0278
Fax Number	:	614-452-9607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	03/29/2024

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