Provider Demographics
NPI:1699551820
Name:GEBRU, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:GEBRU
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 1:14131 SEA WAVE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7003
Mailing Address - Country:US
Mailing Address - Phone:404-988-2881
Mailing Address - Fax:
Practice Address - Street 1:14131 SEA WAVE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7003
Practice Address - Country:US
Practice Address - Phone:404-988-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)