Provider Demographics
NPI:1588230239
Name:GELAW, KIDST GETIE I
Entity Type:Individual
Prefix:
First Name:KIDST
Middle Name:GETIE
Last Name:GELAW
Suffix:I
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 1:7611 MAPLE AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5522
Mailing Address - Country:US
Mailing Address - Phone:202-760-9910
Mailing Address - Fax:
Practice Address - Street 1:7611 MAPLE AVE APT 405
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5522
Practice Address - Country:US
Practice Address - Phone:202-760-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15716374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty