Provider Demographics
NPI:1942819677
Name:WOLDEYOHANNES, HAGUERENESH (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:HAGUERENESH
Middle Name:
Last Name:WOLDEYOHANNES
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 AUSTIN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3887
Mailing Address - Country:US
Mailing Address - Phone:909-561-2650
Mailing Address - Fax:
Practice Address - Street 1:1608 AUSTIN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3887
Practice Address - Country:US
Practice Address - Phone:909-561-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179116176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife