Healthcare Provider Details

I. General information

NPI: 1487396008
Provider Name (Legal Business Name): DEBRIE YIBEYIN HOBGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

IV. Provider business mailing address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

V. Phone/Fax

Practice location:
  • Phone: 347-798-6943
  • Fax:
Mailing address:
  • Phone: 202-384-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA20220922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: