Provider Demographics
NPI:1538769443
Name:NGO NYECK, MARIE ANNE
Entity type:Individual
Prefix:
First Name:MARIE ANNE
Middle Name:
Last Name:NGO NYECK
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 1:1836 METZEROTT RD APT T7
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3441
Mailing Address - Country:US
Mailing Address - Phone:240-713-7946
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT T7
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3441
Practice Address - Country:US
Practice Address - Phone:240-713-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00180177376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide