Provider Demographics
NPI:1245081017
Name:MOKONYA, ANNIE NLIBA
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:NLIBA
Last Name:MOKONYA
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 1:1014 WOODSON RD APT E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2892
Mailing Address - Country:US
Mailing Address - Phone:301-452-1371
Mailing Address - Fax:
Practice Address - Street 1:1014 WOODSON RD APT E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2892
Practice Address - Country:US
Practice Address - Phone:301-452-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator