Provider Demographics
NPI:1033624226
Name:ADMASSU, SELAM WORKU
Entity Type:Individual
Prefix:
First Name:SELAM
Middle Name:WORKU
Last Name:ADMASSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 V ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4027
Mailing Address - Country:US
Mailing Address - Phone:202-910-2463
Mailing Address - Fax:
Practice Address - Street 1:1003 V ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4027
Practice Address - Country:US
Practice Address - Phone:202-910-2463
Practice Address - Fax:202-910-2463
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13231374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13231OtherDEPARTMENT OF HEALTH