Provider Demographics
NPI:1801270434
Name:MAURINE, ABO
Entity type:Individual
Prefix:
First Name:ABO
Middle Name:
Last Name:MAURINE
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 1:1917 FOX ST
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2367
Mailing Address - Country:US
Mailing Address - Phone:301-792-2394
Mailing Address - Fax:
Practice Address - Street 1:1917 FOX ST
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-2367
Practice Address - Country:US
Practice Address - Phone:301-792-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11389390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA11389OtherHOME HEALTH AIDE