Provider Demographics
NPI:1265856165
Name:GEBREBERHAN, YONAS
Entity Type:Individual
Prefix:
First Name:YONAS
Middle Name:
Last Name:GEBREBERHAN
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 1:1421 PARK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1579
Mailing Address - Country:US
Mailing Address - Phone:612-872-8811
Mailing Address - Fax:612-872-8866
Practice Address - Street 1:1421 PARK AVE STE 104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1579
Practice Address - Country:US
Practice Address - Phone:612-872-8811
Practice Address - Fax:612-872-8866
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 181829-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse