Provider Demographics
NPI:1679397319
Name:TESSEMA, AZEB BEFEKADU (NP)
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:BEFEKADU
Last Name:TESSEMA
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 1:306 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1228
Mailing Address - Country:US
Mailing Address - Phone:240-817-7040
Mailing Address - Fax:
Practice Address - Street 1:306 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1228
Practice Address - Country:US
Practice Address - Phone:240-817-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily