Healthcare Provider Details

I. General information

NPI: 1235486101
Provider Name (Legal Business Name): MAHLETE NUGUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 UPSHUR ST NW
WASHINGTON DC
20011-5837
US

IV. Provider business mailing address

820 UPSHUR ST NW
WASHINGTON DC
20011-5837
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-0304
  • Fax: 202-723-0367
Mailing address:
  • Phone: 202-723-0304
  • Fax: 202-723-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHS2164
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: