Provider Demographics
NPI:1235847120
Name:BEKELE, MESERET SHIFERAW
Entity Type:Individual
Prefix:
First Name:MESERET
Middle Name:SHIFERAW
Last Name:BEKELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 GOOSE WATCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6725
Mailing Address - Country:US
Mailing Address - Phone:702-883-3390
Mailing Address - Fax:
Practice Address - Street 1:6767 GOOSE WATCH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6725
Practice Address - Country:US
Practice Address - Phone:702-883-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV856237363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology