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General NPI Number Information
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NPI Number | 1528612397
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Entity Type | Individual
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Provider Name | TIZITA GEDEON TESSEMA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 2150 PENNSYLVANIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20037-3201
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Country | US
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Telephone | 202-741-2191
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Fax | 202-741-2791
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Provider Business Mailing Address
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Address Line | 8500 UPPER SKY WAY UNIT 411
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City | LAUREL
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State | MD
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Zip | 20723-5642
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Country | US
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Telephone | 202-489-5987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN1012448
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN1012448
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License Number State | DC
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