MEDICARE: MULUNESH WOLDSILASSIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA1064	DC

General Provider Information

NPI Number	:	1053727214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MULUNESH WOLDSILASSIE

Provider Business Mailing Address
First Line	:	3435 HOLMEAD PL NW
Second Line	:	APT 406
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3417
Country	:	US
Telephone Number	:	240-893-4067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 HOLMEAD PL NW
Second Line	:	APT 406
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3417
Country	:	US
Telephone Number	:	240-893-4067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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