Provider Demographics
NPI:1073874699
Name:ANYE, MIRABEL (HHA)
Entity Type:Individual
Prefix:
First Name:MIRABEL
Middle Name:
Last Name:ANYE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 FERNWOOD TER APT 102
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1651
Mailing Address - Country:US
Mailing Address - Phone:240-696-9387
Mailing Address - Fax:
Practice Address - Street 1:3332 BUCHANAN ST APT 301
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1121
Practice Address - Country:US
Practice Address - Phone:202-706-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA6355374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide