Healthcare Provider Details

I. General information

NPI: 1144919440
Provider Name (Legal Business Name): HANNAH MOKOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6118 BREEZEWOOD COURT APT 203
GREENBELT MD
20770-2077
US

IV. Provider business mailing address

6118 BREEZEWOOD CT APT 203
GREENBELT MD
20770-1188
US

V. Phone/Fax

Practice location:
  • Phone: 202-823-6165
  • Fax:
Mailing address:
  • Phone: 202-823-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: