Provider Demographics
NPI:1063074003
Name:AGONAFER, ETENESH NEGUSSIE I (PRIMERY CARE GIVER)
Entity type:Individual
Prefix:MS
First Name:ETENESH
Middle Name:NEGUSSIE
Last Name:AGONAFER
Suffix:I
Gender:F
Credentials:PRIMERY CARE GIVER
Other - Prefix:MS
Other - First Name:ETENESH
Other - Middle Name:NEGUSSIE
Other - Last Name:AGONAFER
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 3RD ST NE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1405
Mailing Address - Country:US
Mailing Address - Phone:202-378-6288
Mailing Address - Fax:
Practice Address - Street 1:2900 14TH ST NW APT 211
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6802
Practice Address - Country:US
Practice Address - Phone:571-208-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3417554OtherID