Provider Demographics
NPI:1124577853
Name:IBEH, MIRIAMMERCY
Entity Type:Individual
Prefix:
First Name:MIRIAMMERCY
Middle Name:
Last Name:IBEH
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 1:3740 ELY PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3089
Mailing Address - Country:US
Mailing Address - Phone:773-414-9316
Mailing Address - Fax:
Practice Address - Street 1:3740 ELY PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3089
Practice Address - Country:US
Practice Address - Phone:773-414-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00810253376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNA00810253OtherCERTIFIED NURSING ASSISTANT