MEDICARE: JENEBA MANSARAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN500023728	DC

General Provider Information

NPI Number	:	1053248294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENEBA MANSARAY

Provider Business Mailing Address
First Line	:	7600 GEORGIA AVE NW STE 323
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1616
Country	:	US
Telephone Number	:	202-723-3060
Fax Number	:	202-723-3065

Provider Business Practice Location Address
First Line	:	7600 GEORGIA AVE NW STE 323
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1616
Country	:	US
Telephone Number	:	202-723-3060
Fax Number	:	202-723-3065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ JENEBA MANSARAY ” Practice Location

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