Provider Demographics
NPI:1336636034
Name:GIBE, GUDETU B
Entity Type:Individual
Prefix:MISS
First Name:GUDETU
Middle Name:B
Last Name:GIBE
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 1:5158 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2075
Mailing Address - Country:US
Mailing Address - Phone:303-332-4349
Mailing Address - Fax:
Practice Address - Street 1:5158 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2075
Practice Address - Country:US
Practice Address - Phone:303-332-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO093020492343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO093020492OtherNON-MEDICAL TRANSPORTATION