Provider Demographics
NPI:1073164794
Name:MEBRAHTU, RUTH WOLDEYOHANNES
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:WOLDEYOHANNES
Last Name:MEBRAHTU
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 1:1093 RUATAN ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3224
Mailing Address - Country:US
Mailing Address - Phone:651-757-8410
Mailing Address - Fax:
Practice Address - Street 1:1093 RUATAN ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3224
Practice Address - Country:US
Practice Address - Phone:651-757-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
DCHHA13392374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician