Provider Demographics
NPI:1841979655
Name:KEBBIE, LANGO PATRICIA
Entity type:Individual
Prefix:
First Name:LANGO
Middle Name:PATRICIA
Last Name:KEBBIE
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 1:12201 KINGSBROOK ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1980
Mailing Address - Country:US
Mailing Address - Phone:301-454-9142
Mailing Address - Fax:
Practice Address - Street 1:12201 KINGSBROOK ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1980
Practice Address - Country:US
Practice Address - Phone:301-454-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200002632374U00000X
DCHHA200002632374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide