Provider Demographics
NPI:1174140990
Name:KEBEDE, AZEB GIRMA (NP)
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:GIRMA
Last Name:KEBEDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SUTHERLAND HILL WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4205
Mailing Address - Country:US
Mailing Address - Phone:301-529-7580
Mailing Address - Fax:
Practice Address - Street 1:11511 SUTHERLAND HILL WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4205
Practice Address - Country:US
Practice Address - Phone:301-529-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner