Provider Demographics
NPI:1154838100
Name:GEBREWOLD, WUBSHET
Entity Type:Individual
Prefix:
First Name:WUBSHET
Middle Name:
Last Name:GEBREWOLD
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 1:924 INGRAHAM ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3934
Mailing Address - Country:US
Mailing Address - Phone:202-560-3557
Mailing Address - Fax:
Practice Address - Street 1:924 INGRAHAM ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3934
Practice Address - Country:US
Practice Address - Phone:202-560-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide