Provider Demographics
NPI:1093915720
Name:WOLDEAB, DANIEL G (ACUTE CARE NURSE PRA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:WOLDEAB
Suffix:
Gender:M
Credentials:ACUTE CARE NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S GREENE STREET
Mailing Address - Street 2:UNIVERSITY OF MARYLAND MEDICAL CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-5382
Mailing Address - Fax:410-328-5481
Practice Address - Street 1:21 S GREENE STREET
Practice Address - Street 2:UNIVERSITY OF MARYLAND MEDICAL CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-5382
Practice Address - Fax:410-328-5481
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR123373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care