Provider Demographics
NPI:1962055665
Name:MEKONNEN, YESHITLA BELAY
Entity type:Individual
Prefix:
First Name:YESHITLA
Middle Name:BELAY
Last Name:MEKONNEN
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 1:12038 CHASE CROSSING CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4764
Mailing Address - Country:US
Mailing Address - Phone:301-316-8187
Mailing Address - Fax:
Practice Address - Street 1:100 FORT DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7423
Practice Address - Country:US
Practice Address - Phone:202-568-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant