Provider Demographics
NPI:1538860796
Name:MEKONNEN, NAHOM
Entity type:Individual
Prefix:
First Name:NAHOM
Middle Name:
Last Name:MEKONNEN
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:PO BOX 31065
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80041-0065
Mailing Address - Country:US
Mailing Address - Phone:720-285-8602
Mailing Address - Fax:
Practice Address - Street 1:1509 S SABLE BLVD APT C
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5548
Practice Address - Country:US
Practice Address - Phone:720-285-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver