Provider Demographics
NPI:1891667739
Name:NEGERI, SARA FANTAHUN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:FANTAHUN
Last Name:NEGERI
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 1:5801 EDSALL RD APT 203
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4158
Mailing Address - Country:US
Mailing Address - Phone:571-842-3692
Mailing Address - Fax:
Practice Address - Street 1:5801 EDSALL RD APT 203
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4158
Practice Address - Country:US
Practice Address - Phone:571-842-3692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty