Provider Demographics
NPI:1801500061
Name:TILAHUN, BETHLEHEM (RN)
Entity type:Individual
Prefix:
First Name:BETHLEHEM
Middle Name:
Last Name:TILAHUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 OPITZ BLVD STE 105B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3342
Mailing Address - Country:US
Mailing Address - Phone:571-343-5907
Mailing Address - Fax:571-343-5908
Practice Address - Street 1:2200 OPITZ BLVD STE 105B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3342
Practice Address - Country:US
Practice Address - Phone:571-343-5907
Practice Address - Fax:571-343-5908
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-231870374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide