Provider Demographics
NPI:1790933760
Name:WOLDESEMAYAT, MAHLET BERHANU (RN)
Entity Type:Individual
Prefix:
First Name:MAHLET
Middle Name:BERHANU
Last Name:WOLDESEMAYAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 KARL RD APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1121
Mailing Address - Country:US
Mailing Address - Phone:614-378-6487
Mailing Address - Fax:
Practice Address - Street 1:4495 KARL RD APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1121
Practice Address - Country:US
Practice Address - Phone:614-378-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH307649163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health