Provider Demographics
NPI:1104424043
Name:NIGUSE, ASFAW
Entity type:Individual
Prefix:
First Name:ASFAW
Middle Name:
Last Name:NIGUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5571
Mailing Address - Country:US
Mailing Address - Phone:240-478-0075
Mailing Address - Fax:
Practice Address - Street 1:7600 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5571
Practice Address - Country:US
Practice Address - Phone:240-478-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20202033Medicaid