Provider Demographics
NPI:1366867392
Name:NYANGONO, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:NYANGONO
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 1:5341 85TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3210
Mailing Address - Country:US
Mailing Address - Phone:301-408-8763
Mailing Address - Fax:
Practice Address - Street 1:5341 85TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3210
Practice Address - Country:US
Practice Address - Phone:301-408-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1026427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse