MEDICARE: SENAIT TEKOLA GEBREMEDHIN

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	163WH0200X	Home Health Registered Nurse	472970	OH

General Provider Information

NPI Number	:	1487464442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SENAIT TEKOLA GEBREMEDHIN

Provider Business Mailing Address
First Line	:	689 PARK AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2115
Country	:	US
Telephone Number	:	513-975-9713
Fax Number	:

Provider Business Practice Location Address
First Line	:	689 PARK AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2115
Country	:	US
Telephone Number	:	513-975-9713
Fax Number	:

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

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/11/2025

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