Provider Demographics
NPI:1689824104
Name:MAHONEY, SONJA LISA (LPN)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:LISA
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:LISA
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3195 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3201
Mailing Address - Country:US
Mailing Address - Phone:301-645-3425
Mailing Address - Fax:301-893-8737
Practice Address - Street 1:3195 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3201
Practice Address - Country:US
Practice Address - Phone:301-645-3425
Practice Address - Fax:301-893-8737
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP33111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse