Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AC002948 | MD |
NPI | 1013516590 |
---|---|
Provider Name | Yohannes Berihun Tegegne |
First Address | Alexandria, VA 22304-3572 |
Second Address | Baltimore, MD 21202-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 26/10/2020 |