Provider Demographics
NPI:1437643913
Name:DIANE CARINE, NGONO MPILLA
Entity Type:Individual
Prefix:
First Name:NGONO MPILLA
Middle Name:
Last Name:DIANE CARINE
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 1:5231 KENILWORTH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2853
Mailing Address - Country:US
Mailing Address - Phone:720-609-0000
Mailing Address - Fax:
Practice Address - Street 1:5231 KENILWORTH AVE APT 301
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2853
Practice Address - Country:US
Practice Address - Phone:720-609-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13739374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide