Healthcare Provider Details

I. General information

NPI: 1699032201
Provider Name (Legal Business Name): TIGIST GEBRESELASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 9TH ST NW
WASHINGTON DC
20001-3344
US

IV. Provider business mailing address

7826 EASTERN AVE NW STE 400
WASHINGTON DC
20012-1316
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-9111
  • Fax:
Mailing address:
  • Phone: 202-545-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: