Provider Demographics
NPI:1316209414
Name:AYUK, MARY LUM
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUM
Last Name:AYUK
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 1:202 PINECOVE AVE
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1082
Mailing Address - Country:US
Mailing Address - Phone:443-306-9211
Mailing Address - Fax:
Practice Address - Street 1:202 PINECOVE AVE
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1082
Practice Address - Country:US
Practice Address - Phone:443-306-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide