Provider Demographics
NPI:1699248450
Name:ELALA, MULU HUBENA
Entity type:Individual
Prefix:
First Name:MULU
Middle Name:HUBENA
Last Name:ELALA
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 1:812 JEFFERSON ST NW APT 116
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2922
Mailing Address - Country:US
Mailing Address - Phone:202-375-0522
Mailing Address - Fax:
Practice Address - Street 1:812 JEFFERSON ST NW APT 116
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2922
Practice Address - Country:US
Practice Address - Phone:202-375-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13505374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide