Provider Demographics
NPI:1629558135
Name:TAFOR, ROBERTA NGELOH (MISS)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:NGELOH
Last Name:TAFOR
Suffix:
Gender:F
Credentials:MISS
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:NGELOH
Other - Last Name:TAFOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11916 FROST DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4429
Mailing Address - Country:US
Mailing Address - Phone:301-549-2058
Mailing Address - Fax:
Practice Address - Street 1:11916 FROST DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4429
Practice Address - Country:US
Practice Address - Phone:240-330-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13871374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HHA13871OtherDISTRICT OF COLUMBIA BOARD OF NURSING