Provider Demographics
NPI:1629836986
Name:TECLEAB, ZAID AFEWORKI
Entity Type:Individual
Prefix:
First Name:ZAID
Middle Name:AFEWORKI
Last Name:TECLEAB
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 1:7891 BLACK WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-5034
Mailing Address - Country:US
Mailing Address - Phone:614-371-5345
Mailing Address - Fax:
Practice Address - Street 1:7891 BLACK WILLOW DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-5034
Practice Address - Country:US
Practice Address - Phone:614-371-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400471660305376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide