Healthcare Provider Details

I. General information

NPI: 1629471909
Provider Name (Legal Business Name): LIDIYA GETHUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

IV. Provider business mailing address

16624 CRABBS BRANCH WAY
ROCKVILLE MD
20855-2221
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-8850
  • Fax:
Mailing address:
  • Phone: 301-814-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR221247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: