Provider Demographics
NPI:1548756463
Name:DEREJE, ZENA ABEBE
Entity Type:Individual
Prefix:
First Name:ZENA
Middle Name:ABEBE
Last Name:DEREJE
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 1:2000 FAIRWAY WINDS CT
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5096
Mailing Address - Country:US
Mailing Address - Phone:310-592-5316
Mailing Address - Fax:
Practice Address - Street 1:2000 FAIRWAY WINDS CT
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5096
Practice Address - Country:US
Practice Address - Phone:310-592-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343806164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse