Healthcare Provider Details

I. General information

NPI: 1770124810
Provider Name (Legal Business Name): MITSLAL AFEWORK GEBREKAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 13TH ST NW APT 202
WASHINGTON DC
20009-4480
US

IV. Provider business mailing address

1829 13TH ST NW APT 202
WASHINGTON DC
20009-4480
US

V. Phone/Fax

Practice location:
  • Phone: 202-867-7064
  • Fax:
Mailing address:
  • Phone: 202-867-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA67313169
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: