MEDICARE: BETENASE MAMUYE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497516207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETENASE MAMUYE

Provider Business Mailing Address
First Line	:	1001 LAWRENCE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-3513
Country	:	US
Telephone Number	:	202-635-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8811 COLESVILLE RD APT 202
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4354
Country	:	US
Telephone Number	:	240-476-7308
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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Directions to “ BETENASE MAMUYE ” Practice Location

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