Healthcare Provider Details

I. General information

NPI: 1053673475
Provider Name (Legal Business Name): MERCY DONGMO HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 PENNSYLVANIA AVE SE # LL
WASHINGTON DC
20020-3865
US

IV. Provider business mailing address

2811 PENNSYLVANIA AVE SE # LL
WASHINGTON DC
20020-3865
US

V. Phone/Fax

Practice location:
  • Phone: 202-894-6811
  • Fax:
Mailing address:
  • Phone: 202-894-6811
  • Fax: 202-545-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN500013000
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: