Provider Demographics
NPI:1467342758
Name:MENGESHA, MULUWORK
Entity type:Individual
Prefix:
First Name:MULUWORK
Middle Name:
Last Name:MENGESHA
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 1:7113 LAYTON CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5566
Mailing Address - Country:US
Mailing Address - Phone:443-341-6858
Mailing Address - Fax:
Practice Address - Street 1:2245 ROLLING RUN DR
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1858
Practice Address - Country:US
Practice Address - Phone:410-265-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212126163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis