Healthcare Provider Details

I. General information

NPI: 1225540503
Provider Name (Legal Business Name): MISS TSIGEREDA GETACHEW NIGUSSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 L ST NW SUIT 900
WASHINGTON DC
20036
US

IV. Provider business mailing address

12701 TRUTHS PROMISE CT
BOWIE MD
20720-5600
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1025635
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: