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Makeda Domoz Haileselassie

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

900 23rd St NW, Washington, DC 20037-2342

PECOS Enrollment

This provider is enrolled in PECOS as MAKEDA HAILESELASSIE.

Based on the most recent information from CMS, provider Makeda Domoz Haileselassie is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1720228323
Provider Type
Individual
Full Name
Haileselassie, Makeda Domoz
Credential
FNP

Gender
Female
Sole Proprietor
No
Enumeration Date
2/23/2009
Last Updated
11/21/2022

Contact Information

Practice Location

900 23rd St NW, Washington, DC 20037-2342

(202) 715-5060

(202) 741-3396

Mailing Location

6352 Dakine Cir, Springfield, VA 22150-1194

(703) 869-4238

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License RN1002147 District of Columbia

Makeda Domoz Haileselassie

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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