Provider Demographics
NPI:1871333013
Name:BERKENEH, AZEB ZENEBE (CERTIFICATE)
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:ZENEBE
Last Name:BERKENEH
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 BALLINGER TER
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2022
Mailing Address - Country:US
Mailing Address - Phone:240-887-3497
Mailing Address - Fax:
Practice Address - Street 1:14221 BALLINGER TER
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2022
Practice Address - Country:US
Practice Address - Phone:240-887-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003775374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide