MEDICARE: MOKONNEN B WOBE HHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	CAPTH1153	DC

General Provider Information

NPI Number	:	1417201815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOKONNEN B WOBE HHA

Provider Business Mailing Address
First Line	:	3925 GEORGIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5860
Country	:	US
Telephone Number	:	202-527-2959
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 7TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2207
Country	:	US
Telephone Number	:	202-527-2959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	11/07/2012

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Directions to “ MOKONNEN B WOBE HHA” Practice Location

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