Healthcare Provider Details

I. General information

NPI: 1477211258
Provider Name (Legal Business Name): WOGAYEHU BEKELE GEBREKIDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 HARVARD ST NW
WASHINGTON DC
20001-2910
US

IV. Provider business mailing address

614 HARVARD ST NW
WASHINGTON DC
20001-2910
US

V. Phone/Fax

Practice location:
  • Phone: 202-967-6174
  • Fax:
Mailing address:
  • Phone: 202-967-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA20213527
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: