Provider Demographics
NPI:1487415055
Name:GEBREYES, AZEB (HCA)
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:
Last Name:GEBREYES
Suffix:
Gender:F
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 LAKE WASHINGTON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6329
Mailing Address - Country:US
Mailing Address - Phone:619-757-5625
Mailing Address - Fax:
Practice Address - Street 1:6233 LAKE WASHINGTON BLVD SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6329
Practice Address - Country:US
Practice Address - Phone:619-757-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA756665374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide