Provider Demographics
NPI:1356135982
Name:MEWENEMESSE, MAWABA DONALD
Entity type:Individual
Prefix:
First Name:MAWABA
Middle Name:DONALD
Last Name:MEWENEMESSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 S 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1899
Mailing Address - Country:US
Mailing Address - Phone:402-706-7872
Mailing Address - Fax:
Practice Address - Street 1:5020 COPPER CREEK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68157-2906
Practice Address - Country:US
Practice Address - Phone:402-706-7872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist