Provider Demographics
NPI:1437202801
Name:TESFAMARIAM, WORKU (LPN)
Entity Type:Individual
Prefix:
First Name:WORKU
Middle Name:
Last Name:TESFAMARIAM
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9504 LAWNSBERRY TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4714
Mailing Address - Country:US
Mailing Address - Phone:301-585-5474
Mailing Address - Fax:
Practice Address - Street 1:9504 LAWNSBERRY TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4714
Practice Address - Country:US
Practice Address - Phone:301-585-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP35894164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse