Provider Demographics
NPI:1558975169
Name:AMSHALU, NEBIYOU ALMAW
Entity Type:Individual
Prefix:
First Name:NEBIYOU
Middle Name:ALMAW
Last Name:AMSHALU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SKY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-9630
Mailing Address - Country:US
Mailing Address - Phone:707-337-9900
Mailing Address - Fax:
Practice Address - Street 1:2751 NAPA VALLEY CORPORATE DR BLDG B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6216
Practice Address - Country:US
Practice Address - Phone:707-227-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41423167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician