Provider Demographics
NPI:1265842314
Name:NGOLO NTSEDE, MARIE ANNE
Entity Type:Individual
Prefix:
First Name:MARIE ANNE
Middle Name:
Last Name:NGOLO NTSEDE
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 1:3039 GATEHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3026
Mailing Address - Country:US
Mailing Address - Phone:240-389-7584
Mailing Address - Fax:
Practice Address - Street 1:3039 GATEHOUSE CT
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3026
Practice Address - Country:US
Practice Address - Phone:240-389-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10517374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide