MEDICARE: MULUKEN T AYMIERW

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1285406389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MULUKEN T AYMIERW

Provider Business Mailing Address
First Line	:	34 MORRO BAY DR
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4281
Country	:	US
Telephone Number	:	503-810-2428
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 MORRO BAY DR
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4281
Country	:	US
Telephone Number	:	503-810-2428
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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Directions to “ MULUKEN T AYMIERW ” Practice Location

Language	Start Address	Practice Location

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