Provider Demographics
NPI:1093111395
Name:GEBREMARIAM, EDEN (NP, CNM)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:GEBREMARIAM
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 KNOWLES DR STE 11
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1417
Mailing Address - Country:US
Mailing Address - Phone:408-883-8233
Mailing Address - Fax:
Practice Address - Street 1:777 KNOWLES DR STE 11
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1417
Practice Address - Country:US
Practice Address - Phone:415-699-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse