Provider Demographics
NPI:1407487747
Name:GHEBRU, FITHAWIT MULUGETA (FNP)
Entity Type:Individual
Prefix:
First Name:FITHAWIT
Middle Name:MULUGETA
Last Name:GHEBRU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20114 OLD LINE TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7493
Mailing Address - Country:US
Mailing Address - Phone:571-344-3349
Mailing Address - Fax:
Practice Address - Street 1:110 EDDS LN
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5683
Practice Address - Country:US
Practice Address - Phone:703-444-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1056788363LF0000X
VA0024178763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily