Provider Demographics
NPI:1841701067
Name:ATEH, MIRABEL CHE (HHA)
Entity type:Individual
Prefix:
First Name:MIRABEL
Middle Name:CHE
Last Name:ATEH
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 RIVERDALE RD APT 303
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4016
Mailing Address - Country:US
Mailing Address - Phone:240-581-2134
Mailing Address - Fax:
Practice Address - Street 1:7831 RIVERDALE RD APT 303
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4016
Practice Address - Country:US
Practice Address - Phone:240-581-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13185374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13185OtherHEALTH REGULATION AND LICENSING ADMINISTRATION BOARD OF NURSING
DCHHA13185Medicaid