Provider Demographics
NPI:1639544422
Name:KARGBO, MEMUNATU (CNA)
Entity Type:Individual
Prefix:
First Name:MEMUNATU
Middle Name:
Last Name:KARGBO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 STEWART LN APT 303
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2493
Mailing Address - Country:US
Mailing Address - Phone:240-491-1832
Mailing Address - Fax:
Practice Address - Street 1:11640 STEWART LN APT 303
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2493
Practice Address - Country:US
Practice Address - Phone:240-491-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00099588374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide