Healthcare Provider Details

I. General information

NPI: 1467271817
Provider Name (Legal Business Name): HIRUT YIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 WARNER AVE
HYATTSVILLE MD
20784-2410
US

IV. Provider business mailing address

3802 WARNER AVE
HYATTSVILLE MD
20784-2410
US

V. Phone/Fax

Practice location:
  • Phone: 703-992-5299
  • Fax:
Mailing address:
  • Phone: 703-992-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4116
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: