Provider Demographics
NPI:1790043875
Name:GANA, TIFUH MBAYI
Entity Type:Individual
Prefix:
First Name:TIFUH
Middle Name:MBAYI
Last Name:GANA
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 1:11224 EVANS TRL APT 202
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3915
Mailing Address - Country:US
Mailing Address - Phone:240-393-7683
Mailing Address - Fax:
Practice Address - Street 1:2312 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2829
Practice Address - Country:US
Practice Address - Phone:202-635-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide