Provider Demographics
NPI:1023354719
Name:ABEBE, TIRSIT (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TIRSIT
Middle Name:
Last Name:ABEBE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7654 FALLSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1728
Mailing Address - Country:US
Mailing Address - Phone:703-550-5559
Mailing Address - Fax:
Practice Address - Street 1:7654 FALLSWOOD WAY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1728
Practice Address - Country:US
Practice Address - Phone:703-550-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001196736163W00000X
VA1249913251E00000X
0001196736253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No253J00000XAgenciesFoster Care Agency