Provider Demographics
NPI:1386273910
Name:ATEM, MIRAHERTZ ENOW
Entity type:Individual
Prefix:
First Name:MIRAHERTZ
Middle Name:ENOW
Last Name:ATEM
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 1:5420 N MORGAN ST APT 103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3306
Mailing Address - Country:US
Mailing Address - Phone:571-501-4579
Mailing Address - Fax:
Practice Address - Street 1:5420 N MORGAN ST APT 103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-3306
Practice Address - Country:US
Practice Address - Phone:571-501-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program