Healthcare Provider Details

I. General information

NPI: 1629604178
Provider Name (Legal Business Name): SERKALEM MEKONNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 NEW MEXICO AVE NW STE 310
WASHINGTON DC
20016-2739
US

IV. Provider business mailing address

3201 NEW MEXICO AVE NW STE 310
WASHINGTON DC
20016-2739
US

V. Phone/Fax

Practice location:
  • Phone: 202-625-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN1022455
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: