Provider Demographics
NPI:1205261302
Name:GRACE A. TANGYE E, UNKNOWN
Entity type:Individual
Prefix:MRS
First Name:UNKNOWN
Middle Name:
Last Name:GRACE A. TANGYE E
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 1:9773 GOOD LUCK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3335
Mailing Address - Country:US
Mailing Address - Phone:301-202-5738
Mailing Address - Fax:
Practice Address - Street 1:4920 NIAGARA RD
Practice Address - Street 2:SUITE 318-320
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1110
Practice Address - Country:US
Practice Address - Phone:301-982-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide