Provider Demographics
NPI:1275909236
Name:SANI, MOUTIATOU
Entity Type:Individual
Prefix:
First Name:MOUTIATOU
Middle Name:
Last Name:SANI
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 1:9865 GOOD LUCK RD
Mailing Address - Street 2:APT 8
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3203
Mailing Address - Country:US
Mailing Address - Phone:240-423-7366
Mailing Address - Fax:
Practice Address - Street 1:9865 GOOD LUCK RD
Practice Address - Street 2:APT 8
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3203
Practice Address - Country:US
Practice Address - Phone:240-423-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1008002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse