Provider Demographics
NPI:1063836658
Name:GIMITE, SELOME
Entity type:Individual
Prefix:
First Name:SELOME
Middle Name:
Last Name:GIMITE
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 1:820 UPSHUR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5837
Mailing Address - Country:US
Mailing Address - Phone:202-723-0304
Mailing Address - Fax:202-723-0367
Practice Address - Street 1:1301 14TH ST NW APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3629
Practice Address - Country:US
Practice Address - Phone:240-883-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide