Individual
TSGIE KIDANEMARIAM HAILU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4213 WALNEY RD, CHANTILLY, VA 20151-2923
(703) 502-7000
Mailing address
2916 DOVER LN APT 204, FALLS CHURCH, VA 22042-2916
(703) 884-6197
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002099256
VA
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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