Provider Demographics
NPI:1043712946
Name:JEMBRIE, ADISU ZEWDIE
Entity Type:Individual
Prefix:
First Name:ADISU
Middle Name:ZEWDIE
Last Name:JEMBRIE
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 1:902 S CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3643
Mailing Address - Country:US
Mailing Address - Phone:720-385-9100
Mailing Address - Fax:
Practice Address - Street 1:902 S CRYSTAL WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3643
Practice Address - Country:US
Practice Address - Phone:720-385-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver