Healthcare Provider Details

I. General information

NPI: 1487019030
Provider Name (Legal Business Name): YIESAK W. ASFAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 M ST NW
WASHINGTON DC
20001-1205
US

IV. Provider business mailing address

3413 OLIVE BRANCH DR
SILVER SPRING MD
20904-4973
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-3840
  • Fax:
Mailing address:
  • Phone: 301-256-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1014643
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: