Provider Demographics
NPI:1235835703
Name:NYANDEBO, MARY YEI YIE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:YEI YIE
Last Name:NYANDEBO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:YEI YIE
Other - Last Name:NYANDEBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:151 Q ST NE APT 3503
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2291
Mailing Address - Country:US
Mailing Address - Phone:404-992-9086
Mailing Address - Fax:
Practice Address - Street 1:151 Q ST NE APT 3503
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2291
Practice Address - Country:US
Practice Address - Phone:404-992-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00151531374U00000X, 376K00000X
MDAOO151531376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide