Provider Demographics
NPI:1073311155
Name:MOFOR, MARY NADEGE ATIAFACK
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:NADEGE ATIAFACK
Last Name:MOFOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM SEABROOK
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2193
Mailing Address - Country:US
Mailing Address - Phone:240-484-2429
Mailing Address - Fax:
Practice Address - Street 1:6506 LOUISE ST
Practice Address - Street 2:
Practice Address - City:LANHAM SEABROOK
Practice Address - State:MD
Practice Address - Zip Code:20706-2193
Practice Address - Country:US
Practice Address - Phone:240-484-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide