Provider Demographics
NPI:1659022085
Name:WANGALIA, MERCY
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:WANGALIA
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 1:102 BRAMBLEBUSH LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-5968
Mailing Address - Country:US
Mailing Address - Phone:240-615-6614
Mailing Address - Fax:240-470-7049
Practice Address - Street 1:102 BRAMBLEBUSH LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-5968
Practice Address - Country:US
Practice Address - Phone:240-615-6614
Practice Address - Fax:240-470-7049
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251E00000X, 376K00000X, 374U00000X
MDR4933R253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's Aide