Provider Demographics
NPI:1699462622
Name:MEKURIA, HABTAMU MERKEBA
Entity type:Individual
Prefix:
First Name:HABTAMU
Middle Name:MERKEBA
Last Name:MEKURIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 SUNNYSIDE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6939
Mailing Address - Country:US
Mailing Address - Phone:206-698-9870
Mailing Address - Fax:
Practice Address - Street 1:4516 SUNNYSIDE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6939
Practice Address - Country:US
Practice Address - Phone:206-698-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL43PT3G33B344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi