Provider Demographics
NPI:1831808880
Name:NGO MBOG, MARIE ALICE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ALICE
Last Name:NGO MBOG
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 1:1836 METZEROTT RD APT 501
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3444
Mailing Address - Country:US
Mailing Address - Phone:240-643-4215
Mailing Address - Fax:
Practice Address - Street 1:1200 DELAWARE AVE SW APT 725
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3948
Practice Address - Country:US
Practice Address - Phone:202-883-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide