Provider Demographics
NPI:1629723952
Name:NIGUSSIE, KIDIST
Entity Type:Individual
Prefix:MISS
First Name:KIDIST
Middle Name:
Last Name:NIGUSSIE
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 1:5055 SEMINARY RD APT 1640
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2025
Mailing Address - Country:US
Mailing Address - Phone:862-438-4402
Mailing Address - Fax:
Practice Address - Street 1:3400 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-1902
Practice Address - Country:US
Practice Address - Phone:862-438-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program