Provider Demographics
NPI:1366277329
Name:WORKU, FASICA BIRHAN
Entity type:Individual
Prefix:
First Name:FASICA
Middle Name:BIRHAN
Last Name:WORKU
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 1:505 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4624
Mailing Address - Country:US
Mailing Address - Phone:240-330-5786
Mailing Address - Fax:
Practice Address - Street 1:505 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4624
Practice Address - Country:US
Practice Address - Phone:240-330-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004178374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide