Healthcare Provider Details

I. General information

NPI: 1467032433
Provider Name (Legal Business Name): JENNET MABIBSGHO ASEH CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7757 RIVERDALE RD APT 102
NEW CARROLLTON MD
20784-3922
US

IV. Provider business mailing address

9871 GOOD LUCK RD APT 12
LANHAM MD
20706-3229
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-2693
  • Fax:
Mailing address:
  • Phone: 307-675-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA20210824
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: