Provider Demographics
NPI:1104189794
Name:AYUK, MANGA B
Entity type:Individual
Prefix:
First Name:MANGA
Middle Name:B
Last Name:AYUK
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 1:6409 GRENDEL PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5308
Mailing Address - Country:US
Mailing Address - Phone:240-486-3242
Mailing Address - Fax:
Practice Address - Street 1:6409 GRENDEL PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5308
Practice Address - Country:US
Practice Address - Phone:240-486-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN1048570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide