Provider Demographics
NPI:1578130068
Name:GEBRESLASSIE, GETNET
Entity Type:Individual
Prefix:
First Name:GETNET
Middle Name:
Last Name:GEBRESLASSIE
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 1:2021 TALKING ROCK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1862
Mailing Address - Country:US
Mailing Address - Phone:408-921-5512
Mailing Address - Fax:
Practice Address - Street 1:4206 SUNNY CREEK LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4235
Practice Address - Country:US
Practice Address - Phone:408-921-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000048546819172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver