Provider Demographics
NPI:1164115309
Name:MEKONEN, WUBET T
Entity Type:Individual
Prefix:
First Name:WUBET
Middle Name:T
Last Name:MEKONEN
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 1:1380 PEABODY ST NW APT 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1854
Mailing Address - Country:US
Mailing Address - Phone:202-460-5908
Mailing Address - Fax:
Practice Address - Street 1:1380 PEABODY ST NW APT 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1854
Practice Address - Country:US
Practice Address - Phone:202-460-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52675146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant