Provider Demographics
NPI:1609768191
Name:GEBREGZIABHER, EPHREM YOHANNES
Entity type:Individual
Prefix:
First Name:EPHREM
Middle Name:YOHANNES
Last Name:GEBREGZIABHER
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 1:3614 SECREST LNDG
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7180
Mailing Address - Country:US
Mailing Address - Phone:651-235-8973
Mailing Address - Fax:651-235-8973
Practice Address - Street 1:3614 SECREST LNDG
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7180
Practice Address - Country:US
Practice Address - Phone:651-235-8973
Practice Address - Fax:651-235-8973
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)