Provider Demographics
NPI:1265017677
Name:HALIMATOU, MANA
Entity Type:Individual
Prefix:
First Name:MANA
Middle Name:
Last Name:HALIMATOU
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 1:1131 UNIVERSITY BLVD W APT 2007
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3336
Mailing Address - Country:US
Mailing Address - Phone:240-476-1094
Mailing Address - Fax:
Practice Address - Street 1:1131 UNIVERSITY BLVD W APT 2007
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-3336
Practice Address - Country:US
Practice Address - Phone:240-476-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00171414376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide