Provider Demographics
NPI:1104411081
Name:TADELE, GENET GOBAW
Entity type:Individual
Prefix:
First Name:GENET
Middle Name:GOBAW
Last Name:TADELE
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 1:2736 SWEET CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1888
Mailing Address - Country:US
Mailing Address - Phone:240-433-2373
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW STE LL16
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1328
Practice Address - Country:US
Practice Address - Phone:202-723-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20203060374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide