Provider Demographics
NPI:1366237521
Name:GEBREKIDAN, MEBRAHTU HABTEZGI (CNA)
Entity type:Individual
Prefix:
First Name:MEBRAHTU
Middle Name:HABTEZGI
Last Name:GEBREKIDAN
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8349 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4317
Mailing Address - Country:US
Mailing Address - Phone:206-229-1808
Mailing Address - Fax:
Practice Address - Street 1:8349 39TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4317
Practice Address - Country:US
Practice Address - Phone:206-229-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757102251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health