Provider Demographics
NPI:1932569068
Name:MENGESHA, YEMESRACH TESFAYE (MSN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:YEMESRACH
Middle Name:TESFAYE
Last Name:MENGESHA
Suffix:
Gender:F
Credentials:MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 GREENWAY CENTER DR STE 940
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3555
Mailing Address - Country:US
Mailing Address - Phone:301-220-2333
Mailing Address - Fax:
Practice Address - Street 1:7300 HANOVER DR STE 204
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner