Provider Demographics
NPI:1326652272
Name:SIYUM, ETSEGENET KEBEDE
Entity Type:Individual
Prefix:
First Name:ETSEGENET KEBEDE
Middle Name:
Last Name:SIYUM
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 1:611 EDGEWOOD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-4261
Mailing Address - Country:US
Mailing Address - Phone:240-810-4638
Mailing Address - Fax:
Practice Address - Street 1:611 EDGEWOOD ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4261
Practice Address - Country:US
Practice Address - Phone:240-810-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide