Provider Demographics
NPI:1568004505
Name:GEBREYES, EYOUEL KONU
Entity Type:Individual
Prefix:
First Name:EYOUEL
Middle Name:KONU
Last Name:GEBREYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 ROCK CREEK FORD RD NW APT 213
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1727
Mailing Address - Country:US
Mailing Address - Phone:202-390-9368
Mailing Address - Fax:
Practice Address - Street 1:1444 ROCK CREEK FORD RD NW APT 213
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1727
Practice Address - Country:US
Practice Address - Phone:202-390-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant