Provider Demographics
NPI:1336513381
Name:NGUFOR, MANKAH ODETTE
Entity Type:Individual
Prefix:
First Name:MANKAH
Middle Name:ODETTE
Last Name:NGUFOR
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 1:4402 68TH PL # PLACED4
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2025
Mailing Address - Country:US
Mailing Address - Phone:240-486-0439
Mailing Address - Fax:
Practice Address - Street 1:4402 68TH PL
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2025
Practice Address - Country:US
Practice Address - Phone:240-486-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11607374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide