Provider Demographics
NPI:1659134864
Name:DABA, FNU FLORENCE WANGO
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:FLORENCE WANGO
Last Name:DABA
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 1:5237 KENILWORTH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2857
Mailing Address - Country:US
Mailing Address - Phone:240-304-8150
Mailing Address - Fax:
Practice Address - Street 1:5237 KENILWORTH AVE APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2857
Practice Address - Country:US
Practice Address - Phone:240-304-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide