Provider Demographics
NPI:1376299867
Name:ALI, MEAZA YIMER
Entity Type:Individual
Prefix:
First Name:MEAZA
Middle Name:YIMER
Last Name:ALI
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 1:11133 CHERRYVALE TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3848
Mailing Address - Country:US
Mailing Address - Phone:240-478-8880
Mailing Address - Fax:
Practice Address - Street 1:11133 CHERRYVALE TER
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3848
Practice Address - Country:US
Practice Address - Phone:240-478-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00185483376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide