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1558851063 NPI number — SHIWORKE WOLDESEMAIT

NPI Number: 1558851063
Health Care Provider/Practitioner: SHIWORKE WOLDESEMAIT

Information about “1558851063” NPI (SHIWORKE WOLDESEMAIT) exists in 1558851063 in HTML format HTML  |  1558851063 in plain Text format TXT  |  1558851063 in PDF (Portable Document Format) PDF  |  1558851063 in an XML format XML  formats.

NPI Number : 1558851063 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558851063",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOLDESEMAIT",
    "FirstName": "SHIWORKE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "910 15TH ST NW APT 1002",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WASHINGTON",
    "MailingAddressStateName": "DC",
    "MailingAddressPostalCode": "20005-2521",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "615-260-6572",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2440 M ST NW STE 709",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WASHINGTON",
    "PracticeLocationAddressStateName": "DC",
    "PracticeLocationAddressPostalCode": "20037-1496",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "202-750-8718",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/10/2018",
    "LastUpdateDate": "04/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "9260",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DEN2000083",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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