Provider Demographics
NPI:1033476098
Name:KIMANGU, JANE (HHA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KIMANGU
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 KIRKWOOD PL APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2613
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:
Practice Address - Street 1:2608 KIRKWOOD PL APT 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2613
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide