Provider Demographics
NPI:1346099454
Name:MAMO, FIKIRTEMARIAM
Entity type:Individual
Prefix:
First Name:FIKIRTEMARIAM
Middle Name:
Last Name:MAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 BANDERA DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-7315
Mailing Address - Country:US
Mailing Address - Phone:214-901-1613
Mailing Address - Fax:
Practice Address - Street 1:5721 BANDERA DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-7315
Practice Address - Country:US
Practice Address - Phone:214-901-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6F4T5C8376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide