Provider Demographics
NPI:1194208967
Name:KEBEDE, GENET GEZAHEGN
Entity Type:Individual
Prefix:
First Name:GENET
Middle Name:GEZAHEGN
Last Name:KEBEDE
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 1:4000 MASSACHUSETTS AVE NW APT 911
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5126
Mailing Address - Country:US
Mailing Address - Phone:202-552-9199
Mailing Address - Fax:
Practice Address - Street 1:4000 MASSACHUSETTS AVE NW APT 911
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5126
Practice Address - Country:US
Practice Address - Phone:202-552-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13682374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide