Provider Demographics
NPI:1720877285
Name:HAILU, WONDWOSSEN
Entity type:Individual
Prefix:
First Name:WONDWOSSEN
Middle Name:
Last Name:HAILU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1903
Mailing Address - Country:US
Mailing Address - Phone:301-578-4179
Mailing Address - Fax:
Practice Address - Street 1:2316 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1903
Practice Address - Country:US
Practice Address - Phone:301-578-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide