Provider Demographics
NPI:1215633243
Name:ABEDELA, MENTEWABE FERESSA
Entity type:Individual
Prefix:MRS
First Name:MENTEWABE
Middle Name:FERESSA
Last Name:ABEDELA
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:PO BOX 92777
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20090-2777
Mailing Address - Country:US
Mailing Address - Phone:202-615-1078
Mailing Address - Fax:
Practice Address - Street 1:1160 1ST ST NE APT 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4699
Practice Address - Country:US
Practice Address - Phone:202-615-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2847594OtherDC DRIVER'S LICENSE