Healthcare Provider Details

I. General information

NPI: 1891456778
Provider Name (Legal Business Name): MESSERET MEKONNEN ASSEGHID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAWRENCE ST NE
WASHINGTON DC
20017-3513
US

IV. Provider business mailing address

1001 LAWRENCE ST NE
WASHINGTON DC
20017-3513
US

V. Phone/Fax

Practice location:
  • Phone: 202-431-3183
  • Fax: 202-635-5950
Mailing address:
  • Phone: 202-421-3183
  • Fax: 202-635-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN1025831
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: