Provider Demographics
NPI:1619403599
Name:KEBEDE, ESKEDAR
Entity Type:Individual
Prefix:
First Name:ESKEDAR
Middle Name:
Last Name:KEBEDE
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 1:2309 FREETOWN CT UNIT 12C
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-6216
Mailing Address - Country:US
Mailing Address - Phone:703-229-7731
Mailing Address - Fax:
Practice Address - Street 1:2309 FREETOWN CT UNIT 12C
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-6216
Practice Address - Country:US
Practice Address - Phone:703-229-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant