Provider Demographics
NPI:1932894839
Name:FEREDE, BISRAT
Entity Type:Individual
Prefix:
First Name:BISRAT
Middle Name:
Last Name:FEREDE
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 1:1320 CENTRAL PARK BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4958
Mailing Address - Country:US
Mailing Address - Phone:571-275-9819
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD STE 245
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4958
Practice Address - Country:US
Practice Address - Phone:571-275-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
VAHCO-253271251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty