Provider Demographics
NPI:1629881115
Name:MUKUNDANE, JEMAH (CNA)
Entity type:Individual
Prefix:
First Name:JEMAH
Middle Name:
Last Name:MUKUNDANE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20008 SWEETGUM CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3759
Mailing Address - Country:US
Mailing Address - Phone:202-459-3326
Mailing Address - Fax:
Practice Address - Street 1:4455 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2324
Practice Address - Country:US
Practice Address - Phone:240-994-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001947083747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant