Provider Demographics
NPI:1376872077
Name:BERHANU, AMEN N (RN)
Entity Type:Individual
Prefix:MR
First Name:AMEN
Middle Name:N
Last Name:BERHANU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N 204TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3113
Mailing Address - Country:US
Mailing Address - Phone:206-542-7403
Mailing Address - Fax:206-542-7457
Practice Address - Street 1:734 N 204TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3113
Practice Address - Country:US
Practice Address - Phone:206-542-7403
Practice Address - Fax:206-542-7457
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#750903374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide