Healthcare Provider Details

I. General information

NPI: 1811032246
Provider Name (Legal Business Name): YODIT KAFEL HAILEAB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date: 03/21/2012
Reactivation Date: 07/21/2022

III. Provider practice location address

3247 ELEANORS GARDEN WAY
WOODBINE MD
21797
US

IV. Provider business mailing address

3247 ELEANORS GARDEN WAY
WOODBINE MD
21797
US

V. Phone/Fax

Practice location:
  • Phone: 301-526-4092
  • Fax: 410-489-7996
Mailing address:
  • Phone: 301-526-4092
  • Fax: 410-489-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR172148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: