Provider Demographics
NPI:1407114556
Name:GANA, MIRABEL
Entity Type:Individual
Prefix:
First Name:MIRABEL
Middle Name:
Last Name:GANA
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 1:6902 HIGHVIEW TER APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4016
Mailing Address - Country:US
Mailing Address - Phone:240-715-8889
Mailing Address - Fax:
Practice Address - Street 1:6902 HIGHVIEW TER APT 202
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4016
Practice Address - Country:US
Practice Address - Phone:240-715-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide