Provider Demographics
NPI:1902675424
Name:ELMOGE, MARYAMO MUHUMED
Entity Type:Individual
Prefix:
First Name:MARYAMO
Middle Name:MUHUMED
Last Name:ELMOGE
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 1:511 40TH ST S APT 306
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1162
Mailing Address - Country:US
Mailing Address - Phone:218-790-6623
Mailing Address - Fax:
Practice Address - Street 1:2512 7TH AVE S STE F1
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8747
Practice Address - Country:US
Practice Address - Phone:218-790-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care