Provider Demographics
NPI:1245591023
Name:FORGANG, CELINE MBAYI
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:MBAYI
Last Name:FORGANG
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 1:11556 FEBRUARY CIR
Mailing Address - Street 2:APT 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6924
Mailing Address - Country:US
Mailing Address - Phone:713-449-3595
Mailing Address - Fax:
Practice Address - Street 1:11556 FEBRUARY CIR
Practice Address - Street 2:APT 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6924
Practice Address - Country:US
Practice Address - Phone:713-449-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF625112596623374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide