Provider Demographics
NPI:1487911046
Name:DELELEGN, ADDIS A
Entity type:Individual
Prefix:
First Name:ADDIS
Middle Name:A
Last Name:DELELEGN
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 1:1440 ROCK CREEK FORD RD NW
Mailing Address - Street 2:APT# 209
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1440 ROCK CREEK FORD RD NW
Practice Address - Street 2:APT# 209
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1701
Practice Address - Country:US
Practice Address - Phone:202-722-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide