Basic Information
| Provider Information | |||||||||
| NPI: | 1912262015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARGBO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MIATTA | ||||||||
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| Credential: | HHA, REGISTERED NURS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15405 EMMANUAL WAY | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207161265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2407064347 | ||||||||
| FaxNumber: | 2407064347 | ||||||||
| Practice Location | |||||||||
| Address1: | 2637 NICHOLSON ST APT 103 | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207822661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025450935 | ||||||||
| FaxNumber: | 2025450934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | N | Nursing Service Related Providers | Home Health Aide | 163WH0200X | RN1044787 | DC | Y | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.