Provider Demographics
NPI:1295340537
Name:RARU, WUBIT TILAHUN (FNP-BC)
Entity type:Individual
Prefix:
First Name:WUBIT
Middle Name:TILAHUN
Last Name:RARU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56343
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20040-6343
Mailing Address - Country:US
Mailing Address - Phone:240-505-3475
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3689
Practice Address - Country:US
Practice Address - Phone:410-313-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1036586363LF0000X
MDR216540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily