Provider Demographics
NPI:1972352011
Name:MEKONNEN, DEJENE D
Entity type:Individual
Prefix:
First Name:DEJENE
Middle Name:D
Last Name:MEKONNEN
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 1:12500 E ILIFF AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1374
Mailing Address - Country:US
Mailing Address - Phone:720-810-8554
Mailing Address - Fax:
Practice Address - Street 1:12500 E ILIFF AVE STE 220
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1374
Practice Address - Country:US
Practice Address - Phone:720-810-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)