Provider Demographics
NPI:1841855467
Name:TADDESE, SEBLEWONGEL KASSIE (BA)
Entity type:Individual
Prefix:MISS
First Name:SEBLEWONGEL
Middle Name:KASSIE
Last Name:TADDESE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 15TH ST NW APT 901
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5824
Mailing Address - Country:US
Mailing Address - Phone:202-415-2748
Mailing Address - Fax:
Practice Address - Street 1:2001 15TH ST NW APT 901
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5824
Practice Address - Country:US
Practice Address - Phone:202-415-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant