Healthcare Provider Details

I. General information

NPI: 1821733486
Provider Name (Legal Business Name): AZEB T MIESGNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 JUNIPER ST NW
WASHINGTON DC
20012-1633
US

IV. Provider business mailing address

825 JUNIPER ST NW
WASHINGTON DC
20012-1633
US

V. Phone/Fax

Practice location:
  • Phone: 720-621-9561
  • Fax:
Mailing address:
  • Phone: 720-621-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: