Provider Demographics
NPI:1114154986
Name:GHEBRE, GENET NEGASH (CNP)
Entity Type:Individual
Prefix:
First Name:GENET
Middle Name:NEGASH
Last Name:GHEBRE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4847
Mailing Address - Country:US
Mailing Address - Phone:651-307-8016
Mailing Address - Fax:
Practice Address - Street 1:45 10TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-326-3700
Practice Address - Fax:651-326-3706
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP0705363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology