Provider Demographics
NPI:1932926797
Name:MEWUCHA, DAGMAWI
Entity type:Individual
Prefix:
First Name:DAGMAWI
Middle Name:
Last Name:MEWUCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 NW JACKPINE LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9819
Mailing Address - Country:US
Mailing Address - Phone:971-570-8006
Mailing Address - Fax:
Practice Address - Street 1:2495 NW JACKPINE LN
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9819
Practice Address - Country:US
Practice Address - Phone:971-570-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency