Provider Demographics
NPI:1851829204
Name:KANLA, MARY YEFON
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:YEFON
Last Name:KANLA
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 1:4303 CRELIN PL
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1936
Mailing Address - Country:US
Mailing Address - Phone:240-483-8847
Mailing Address - Fax:
Practice Address - Street 1:4303 CRELIN PL
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1936
Practice Address - Country:US
Practice Address - Phone:240-483-8847
Practice Address - Fax:240-483-8847
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC252178481374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide