Healthcare Provider Details

I. General information

NPI: 1144590167
Provider Name (Legal Business Name): ADDIS TAMIRAT MEKURIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 18TH ST NE
WASHINGTON DC
20018-2738
US

IV. Provider business mailing address

1356 BRYANT ST NE APT 2
WASHINGTON DC
20018-1179
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-6510
  • Fax:
Mailing address:
  • Phone: 202-684-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA6429
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: