Provider Demographics
NPI:1316579584
Name:BEYENE, HIRUT
Entity Type:Individual
Prefix:
First Name:HIRUT
Middle Name:
Last Name:BEYENE
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 1:4201 CATHEDRAL AVE NW APT 516E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4954
Mailing Address - Country:US
Mailing Address - Phone:650-759-8287
Mailing Address - Fax:
Practice Address - Street 1:136 BRYANT ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1631
Practice Address - Country:US
Practice Address - Phone:202-384-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14867374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA14867Medicaid