Healthcare Provider Details

I. General information

NPI: 1003354366
Provider Name (Legal Business Name): SEBLE GEBREHAWANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 HAMILTON ST APT. E302
HYATTSVILLE MD
20781-1838
US

IV. Provider business mailing address

3900 HAMILTON ST APT. E302
HYATTSVILLE MD
20781-1838
US

V. Phone/Fax

Practice location:
  • Phone: 301-236-6198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: