Provider Demographics
NPI:1295417442
Name:KEBEDE, MNALU ABEBE SR
Entity type:Individual
Prefix:
First Name:MNALU
Middle Name:ABEBE
Last Name:KEBEDE
Suffix:SR
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 1:3717 S WACO ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3431
Mailing Address - Country:US
Mailing Address - Phone:720-261-8549
Mailing Address - Fax:
Practice Address - Street 1:3717 S WACO ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3431
Practice Address - Country:US
Practice Address - Phone:720-261-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13-134-0594172A00000X, 343900000X
172A00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriverGroup - Single Specialty