Provider Demographics
NPI:1780405001
Name:GETAHUN, AMSALU
Entity type:Individual
Prefix:
First Name:AMSALU
Middle Name:
Last Name:GETAHUN
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 1:818 STICKNEY WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-1010
Mailing Address - Country:US
Mailing Address - Phone:301-318-9131
Mailing Address - Fax:
Practice Address - Street 1:818 STICKNEY WAY
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-1010
Practice Address - Country:US
Practice Address - Phone:301-318-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95192928163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice