Healthcare Provider Details

I. General information

NPI: 1770988164
Provider Name (Legal Business Name): WOYNESHET A MENGISTU GRADUATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE
SILVER SPRING MD
20902-4517
US

IV. Provider business mailing address

2401 BLUERIDGE AVE
SILVER SPRING MD
20902-4517
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-0466
  • Fax: 301-933-2007
Mailing address:
  • Phone: 301-949-0466
  • Fax: 301-933-2007

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: