Provider Demographics
NPI:1912464645
Name:GEBRU, AMBAYE WONDIE (RN)
Entity Type:Individual
Prefix:
First Name:AMBAYE
Middle Name:WONDIE
Last Name:GEBRU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 69TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7743
Mailing Address - Country:US
Mailing Address - Phone:206-229-7706
Mailing Address - Fax:360-691-9955
Practice Address - Street 1:7229 69TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7743
Practice Address - Country:US
Practice Address - Phone:206-229-7706
Practice Address - Fax:360-691-9955
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60242725163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse