Provider Demographics
NPI:1073221289
Name:KEBTIE, MULUSEW GETIE (RN, BSN, MSC)
Entity Type:Individual
Prefix:
First Name:MULUSEW
Middle Name:GETIE
Last Name:KEBTIE
Suffix:
Gender:M
Credentials:RN, BSN, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16730 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1044
Mailing Address - Country:US
Mailing Address - Phone:301-633-9649
Mailing Address - Fax:503-344-6669
Practice Address - Street 1:16730 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1044
Practice Address - Country:US
Practice Address - Phone:301-633-9649
Practice Address - Fax:503-344-6669
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201808581RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse