Healthcare Provider Details

I. General information

NPI: 1144876988
Provider Name (Legal Business Name): MEBRAT GEBREHIWOT GEBREMEDHIN HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 PEABODY ST NW APT 412
WASHINGTON DC
20011-1871
US

IV. Provider business mailing address

1355 PEABODY ST NW APT 412
WASHINGTON DC
20011-1871
US

V. Phone/Fax

Practice location:
  • Phone: 202-790-2804
  • Fax:
Mailing address:
  • Phone: 202-790-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14545
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: