Provider Demographics
NPI:1447895123
Name:NJUALEM, BETANGABEH NADEGE
Entity type:Individual
Prefix:
First Name:BETANGABEH
Middle Name:NADEGE
Last Name:NJUALEM
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 1:2504 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3646
Mailing Address - Country:US
Mailing Address - Phone:240-906-1938
Mailing Address - Fax:
Practice Address - Street 1:2504 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3646
Practice Address - Country:US
Practice Address - Phone:240-906-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide