Healthcare Provider Details

I. General information

NPI: 1306503370
Provider Name (Legal Business Name): NAZRAWIT KEBEDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-7167-337762
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: