Provider Demographics
NPI:1912262015
Name:KARGBO, MARY MIATTA (HHA, REGISTERED NURS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MIATTA
Last Name:KARGBO
Suffix:
Gender:F
Credentials:HHA, REGISTERED NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15405 EMMANUAL WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1265
Mailing Address - Country:US
Mailing Address - Phone:240-706-4347
Mailing Address - Fax:240-706-4347
Practice Address - Street 1:2637 NICHOLSON ST APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2661
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0934
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN1044787163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide