Healthcare Provider Details

I. General information

NPI: 1295411122
Provider Name (Legal Business Name): GENET NEGASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 PENNSYLVANIA AVE LOWER LEVEL
SOUTH EAST DC
20020
US

IV. Provider business mailing address

2811 PENNSYLVANIA AVE LOWER LEVEL
LOWER LEVEL DC
20020
US

V. Phone/Fax

Practice location:
  • Phone: 202-894-6811
  • Fax: 202-894-6811
Mailing address:
  • Phone: 202-894-6811
  • Fax: 202-894-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: