MEDICARE: ATEM NTELAHA

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	374U00000X	Home Health Aide	HHA200003242	DC

General Provider Information

NPI Number	:	1184493231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATEM NTELAHA

Provider Business Mailing Address
First Line	:	3163 QUEENS CHAPEL RD APT 201
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1180
Country	:	US
Telephone Number	:	240-440-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3163 QUEENS CHAPEL RD APT 201
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1180
Country	:	US
Telephone Number	:	240-440-5565
Fax Number	:

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

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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Directions to “ ATEM NTELAHA ” Practice Location

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