Provider Demographics
NPI:1497516207
Name:MAMUYE, BETENASE
Entity Type:Individual
Prefix:
First Name:BETENASE
Middle Name:
Last Name:MAMUYE
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 1:1001 LAWRENCE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3513
Mailing Address - Country:US
Mailing Address - Phone:202-635-5900
Mailing Address - Fax:
Practice Address - Street 1:8811 COLESVILLE RD APT 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4354
Practice Address - Country:US
Practice Address - Phone:240-476-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator