Provider Demographics
NPI:1962157578
Name:MAMO, SENAIT YETAGESSU
Entity type:Individual
Prefix:
First Name:SENAIT
Middle Name:YETAGESSU
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 1:6946 HANOVER PKWY APT 301
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2220
Mailing Address - Country:US
Mailing Address - Phone:612-481-5482
Mailing Address - Fax:
Practice Address - Street 1:6946 HANOVER PKWY APT 301
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2220
Practice Address - Country:US
Practice Address - Phone:612-481-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide