Provider Demographics
NPI:1396337994
Name:MAH EPSE NJEI, MERCY
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:MAH EPSE NJEI
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 1:5807 TIMBER CREEK TER APT 3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2518
Mailing Address - Country:US
Mailing Address - Phone:301-256-4985
Mailing Address - Fax:
Practice Address - Street 1:5807 TIMBER CREEK TER APT 3
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2518
Practice Address - Country:US
Practice Address - Phone:301-256-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15553374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide