Healthcare Provider Details

I. General information

NPI: 1790268555
Provider Name (Legal Business Name): MAGRESTINE MEMEH BEBEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 KENILWORTH AVE
HYATTSVILLE MD
20781-2863
US

IV. Provider business mailing address

5249 KENILWORTH AVE
HYATTSVILLE MD
20781-2863
US

V. Phone/Fax

Practice location:
  • Phone: 443-458-3302
  • Fax:
Mailing address:
  • Phone: 443-458-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13957
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: