Provider Demographics
NPI:1528563368
Name:EKOKO, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:EKOKO
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 1:3803 ASQUITH CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5452
Mailing Address - Country:US
Mailing Address - Phone:240-486-7734
Mailing Address - Fax:
Practice Address - Street 1:3803 ASQUITH CT
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-5452
Practice Address - Country:US
Practice Address - Phone:240-486-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant