Provider Demographics
NPI:1619419934
Name:WOLDHANNA, SEBLEWORK ESHETE (HHA)
Entity Type:Individual
Prefix:
First Name:SEBLEWORK
Middle Name:ESHETE
Last Name:WOLDHANNA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 SEA PORT WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2200
Mailing Address - Country:US
Mailing Address - Phone:240-543-2241
Mailing Address - Fax:
Practice Address - Street 1:3319 SEA PORT WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2200
Practice Address - Country:US
Practice Address - Phone:240-543-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC251E00000XMedicaid