Provider Demographics
NPI:1417624339
Name:GENGATA, GERUMSHOA WOLDE
Entity Type:Individual
Prefix:
First Name:GERUMSHOA
Middle Name:WOLDE
Last Name:GENGATA
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 1:2102 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3139
Mailing Address - Country:US
Mailing Address - Phone:202-386-0351
Mailing Address - Fax:
Practice Address - Street 1:955 LENFANT PLZ SW STE 985
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-6104
Practice Address - Country:US
Practice Address - Phone:202-895-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide