Provider Demographics
NPI:1386115087
Name:WOLDE, GRMAWIT
Entity type:Individual
Prefix:
First Name:GRMAWIT
Middle Name:
Last Name:WOLDE
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 1:512 W 134 #23
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:512 W 134 #23
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NM
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:646-407-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM301729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse