Provider Demographics
NPI:1497102214
Name:ABEBE, ENZI (APRN)
Entity Type:Individual
Prefix:
First Name:ENZI
Middle Name:
Last Name:ABEBE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3314
Mailing Address - Country:US
Mailing Address - Phone:702-309-2311
Mailing Address - Fax:702-309-2177
Practice Address - Street 1:3483 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3314
Practice Address - Country:US
Practice Address - Phone:702-309-2311
Practice Address - Fax:702-309-2177
Is Sole Proprietor?:No
Enumeration Date:2016-05-22
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002210363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology