Provider Demographics
NPI:1700640109
Name:ARAIA, SAMRAWIT GHEBRENGUS
Entity Type:Individual
Prefix:
First Name:SAMRAWIT
Middle Name:GHEBRENGUS
Last Name:ARAIA
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 1:7401 KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3825
Mailing Address - Country:US
Mailing Address - Phone:312-468-5301
Mailing Address - Fax:
Practice Address - Street 1:7401 KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3825
Practice Address - Country:US
Practice Address - Phone:312-468-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily