Healthcare Provider Details

I. General information

NPI: 1538588959
Provider Name (Legal Business Name): HELMAE WUBNEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 BOWMAN GRAY DR
GREENVILLE NC
27834-7215
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-7992
  • Fax: 252-752-2016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2021-03376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: