Provider Demographics
NPI:1053848499
Name:NERRI, GIZACHEW WOURGASSO
Entity Type:Individual
Prefix:
First Name:GIZACHEW
Middle Name:WOURGASSO
Last Name:NERRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 TOWER DR APT 302
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-6532
Mailing Address - Country:US
Mailing Address - Phone:571-236-1679
Mailing Address - Fax:571-255-8005
Practice Address - Street 1:1403 6TH ST NW # 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2418
Practice Address - Country:US
Practice Address - Phone:202-529-1071
Practice Address - Fax:202-635-6832
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60-02-7135343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)