Provider Demographics
NPI:1427688704
Name:WIRBA ESPE ANDANG, MIRABEL SUWUN
Entity type:Individual
Prefix:MS
First Name:MIRABEL
Middle Name:SUWUN
Last Name:WIRBA ESPE ANDANG
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 1:6108 BREEZEWOOD DR APT 304
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4153
Mailing Address - Country:US
Mailing Address - Phone:240-906-7738
Mailing Address - Fax:
Practice Address - Street 1:3500 18TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2738
Practice Address - Country:US
Practice Address - Phone:240-906-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14824374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide