Provider Demographics
NPI:1407442791
Name:MANEFO, ROBERTINE
Entity Type:Individual
Prefix:
First Name:ROBERTINE
Middle Name:
Last Name:MANEFO
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 1:1301 RUPPERT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1025
Mailing Address - Country:US
Mailing Address - Phone:619-243-4659
Mailing Address - Fax:
Practice Address - Street 1:1301 RUPPERT RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1025
Practice Address - Country:US
Practice Address - Phone:619-243-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20202644374U00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide