Provider Demographics
NPI:1134632821
Name:BEYENE, BISRAT
Entity type:Individual
Prefix:
First Name:BISRAT
Middle Name:
Last Name:BEYENE
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 1:855 S FREDERICK ST APT 202
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-2893
Mailing Address - Country:US
Mailing Address - Phone:571-265-6482
Mailing Address - Fax:
Practice Address - Street 1:855 S FREDERICK ST APT 202
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-2893
Practice Address - Country:US
Practice Address - Phone:571-265-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide