Provider Demographics
NPI:1821806779
Name:YALEW, MAHELET ADGO (APRN)
Entity type:Individual
Prefix:
First Name:MAHELET
Middle Name:ADGO
Last Name:YALEW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 EDSALL RD APT 306
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6002
Mailing Address - Country:US
Mailing Address - Phone:571-426-1873
Mailing Address - Fax:
Practice Address - Street 1:6101 EDSALL RD APT 306
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6002
Practice Address - Country:US
Practice Address - Phone:571-426-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192170363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty