Provider Demographics
NPI:1356908032
Name:MPIGAHODI, THECKLA MAFITA
Entity type:Individual
Prefix:
First Name:THECKLA
Middle Name:MAFITA
Last Name:MPIGAHODI
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 1:5201 NEWTON ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2336
Mailing Address - Country:US
Mailing Address - Phone:240-640-2960
Mailing Address - Fax:
Practice Address - Street 1:5201 NEWTON ST APT 201
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2336
Practice Address - Country:US
Practice Address - Phone:240-640-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00050939376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide