Provider Demographics
NPI:1083976997
Name:GEBREMARIAM, BIRTUKAN BIZUAYEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:BIRTUKAN
Middle Name:BIZUAYEN
Last Name:GEBREMARIAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2899
Mailing Address - Country:US
Mailing Address - Phone:301-605-4934
Mailing Address - Fax:
Practice Address - Street 1:7005 22ND AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-2899
Practice Address - Country:US
Practice Address - Phone:301-605-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005514164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse