Provider Demographics
NPI:1346708575
Name:DAMTE, YEALEMZEWD
Entity Type:Individual
Prefix:
First Name:YEALEMZEWD
Middle Name:
Last Name:DAMTE
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 1:207 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7469
Mailing Address - Country:US
Mailing Address - Phone:469-487-3405
Mailing Address - Fax:
Practice Address - Street 1:207 LAKEFRONT DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7469
Practice Address - Country:US
Practice Address - Phone:469-487-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345089164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse