Provider Demographics
NPI:1063772598
Name:MUKETE, ROBERT IVO (HOME HEALTH AIDE)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:IVO
Last Name:MUKETE
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E WEST HWY
Mailing Address - Street 2:APT # 442
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2176
Mailing Address - Country:US
Mailing Address - Phone:301-917-5060
Mailing Address - Fax:
Practice Address - Street 1:3300 E WEST HWY
Practice Address - Street 2:APT # 442
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2176
Practice Address - Country:US
Practice Address - Phone:301-917-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide