Provider Demographics
NPI:1558047589
Name:GEBREHANNA, HIRUT TAFESE
Entity Type:Individual
Prefix:
First Name:HIRUT
Middle Name:TAFESE
Last Name:GEBREHANNA
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 1:13420 MANOR WAY UNIT A2
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5702
Mailing Address - Country:US
Mailing Address - Phone:206-734-1577
Mailing Address - Fax:
Practice Address - Street 1:13420 MANOR WAY UNIT A2
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5702
Practice Address - Country:US
Practice Address - Phone:206-734-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60895755163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty