Provider Demographics
NPI:1083395149
Name:NDO, MARCELINE
Entity Type:Individual
Prefix:
First Name:MARCELINE
Middle Name:
Last Name:NDO
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 1:2600 BRYAN PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4417
Mailing Address - Country:US
Mailing Address - Phone:641-954-2702
Mailing Address - Fax:
Practice Address - Street 1:14208 MADRIGAL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5953
Practice Address - Country:US
Practice Address - Phone:641-954-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200002627163W00000X
DCLPN200002627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse