Provider Demographics
NPI:1952726986
Name:DARBOE, MAMANDING
Entity Type:Individual
Prefix:
First Name:MAMANDING
Middle Name:
Last Name:DARBOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CENTER RD
Mailing Address - Street 2:APT D-101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7893
Mailing Address - Country:US
Mailing Address - Phone:253-576-2986
Mailing Address - Fax:
Practice Address - Street 1:605 CENTER RD
Practice Address - Street 2:APT D-101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7893
Practice Address - Country:US
Practice Address - Phone:253-576-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
WANC60186200376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide