Provider Demographics
NPI:1659774958
Name:AYUK, MARIE AGBOR I
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:AGBOR
Last Name:AYUK
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:AGBOR
Other - Last Name:AYUK
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6210 BELCREST RD
Mailing Address - Street 2:APT.1206
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2952
Mailing Address - Country:US
Mailing Address - Phone:301-455-1366
Mailing Address - Fax:
Practice Address - Street 1:6210 BELCREST RD
Practice Address - Street 2:APT.1206
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2952
Practice Address - Country:US
Practice Address - Phone:301-455-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN100584Q164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse