Healthcare Provider Details

I. General information

NPI: 1982147971
Provider Name (Legal Business Name): SETU GEBREEGZIABHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 SLIGO AVE APT. #302
SILVER SPRING MD
20910-4770
US

IV. Provider business mailing address

733 SLIGO AVE APT. #302
SILVER SPRING MD
20910-4770
US

V. Phone/Fax

Practice location:
  • Phone: 704-890-2509
  • Fax:
Mailing address:
  • Phone: 704-890-2509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12357
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: