Healthcare Provider Details

I. General information

NPI: 1083976997
Provider Name (Legal Business Name): BIRTUKAN BIZUAYEN GEBREMARIAM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 22ND AVE
HYATTSVILLE MD
20783-2899
US

IV. Provider business mailing address

7005 22ND AVE
HYATTSVILLE MD
20783-2899
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-4934
  • Fax:
Mailing address:
  • Phone: 301-605-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLPN1005514
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: