Provider Demographics
NPI:1699508879
Name:ZEWDIE, ASTER TILAHUN
Entity type:Individual
Prefix:
First Name:ASTER
Middle Name:TILAHUN
Last Name:ZEWDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 ANGEL DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1187
Mailing Address - Country:US
Mailing Address - Phone:505-460-7930
Mailing Address - Fax:
Practice Address - Street 1:10401 MONTGOMERY PKWY NE STE 2E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3876
Practice Address - Country:US
Practice Address - Phone:505-460-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCOM-2024-381436374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide