Provider Demographics
NPI:1114723046
Name:MISMAKU, MULUMEBET
Entity type:Individual
Prefix:
First Name:MULUMEBET
Middle Name:
Last Name:MISMAKU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 16TH ST NW APT 22
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2242
Mailing Address - Country:US
Mailing Address - Phone:202-779-8967
Mailing Address - Fax:
Practice Address - Street 1:600 PENNSYLVANIA AVE SE STE 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4344
Practice Address - Country:US
Practice Address - Phone:202-895-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA5024163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health