Provider Demographics
NPI:1902076631
Name:SEBHATU, FANA GEBREHIWET
Entity Type:Individual
Prefix:MISS
First Name:FANA
Middle Name:GEBREHIWET
Last Name:SEBHATU
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 1:15819 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1749
Mailing Address - Country:US
Mailing Address - Phone:313-493-4900
Mailing Address - Fax:313-493-4904
Practice Address - Street 1:15819 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1749
Practice Address - Country:US
Practice Address - Phone:313-493-4900
Practice Address - Fax:313-493-4904
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist