Provider Demographics
NPI:1588482665
Name:BIRHANE, LIYA TEMESGEN
Entity type:Individual
Prefix:
First Name:LIYA
Middle Name:TEMESGEN
Last Name:BIRHANE
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 1:1828 METZEROTT RD APT 308
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3479
Mailing Address - Country:US
Mailing Address - Phone:301-316-8976
Mailing Address - Fax:
Practice Address - Street 1:1828 METZEROTT RD APT 308
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3479
Practice Address - Country:US
Practice Address - Phone:301-316-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00198956376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide