Provider Demographics
NPI:1083480008
Name:AYALEW, AMELEMAL TEZERA
Entity Type:Individual
Prefix:
First Name:AMELEMAL
Middle Name:TEZERA
Last Name:AYALEW
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 1:6000 13TH ST NW APT 111
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5029
Mailing Address - Country:US
Mailing Address - Phone:202-830-5779
Mailing Address - Fax:
Practice Address - Street 1:6000 13TH ST NW APT 111
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5029
Practice Address - Country:US
Practice Address - Phone:202-830-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003001374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide