Provider Demographics
NPI:1316340938
Name:AMARE, ETENESH
Entity type:Individual
Prefix:
First Name:ETENESH
Middle Name:
Last Name:AMARE
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 1:12905 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5138
Mailing Address - Country:US
Mailing Address - Phone:301-806-3025
Mailing Address - Fax:
Practice Address - Street 1:12905 DEAN RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5138
Practice Address - Country:US
Practice Address - Phone:301-806-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005080164W00000X
MDLP45237164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse