Provider Demographics
NPI:1700428133
Name:FENTA, ETEGENET T
Entity Type:Individual
Prefix:
First Name:ETEGENET
Middle Name:T
Last Name:FENTA
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 1:112 FORT DR NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7420
Mailing Address - Country:US
Mailing Address - Phone:571-201-6673
Mailing Address - Fax:
Practice Address - Street 1:112 FORT DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7420
Practice Address - Country:US
Practice Address - Phone:571-201-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide