Provider Demographics
NPI:1356867360
Name:MOKOSO, BLANCHE (FNP)
Entity Type:Individual
Prefix:
First Name:BLANCHE
Middle Name:
Last Name:MOKOSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 SPRINGPARK COURT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769
Mailing Address - Country:US
Mailing Address - Phone:301-728-3783
Mailing Address - Fax:
Practice Address - Street 1:6192 OXON HILL RD STE 507
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3142
Practice Address - Country:US
Practice Address - Phone:301-839-0800
Practice Address - Fax:301-839-8088
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR229094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily