MEDICARE: AMINATA MANSARAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP37002	MD

General Provider Information

NPI Number	:	1457754715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINATA MANSARAY

Provider Business Mailing Address
First Line	:	849 FAIRMOUNT AVE
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 FAIRMOUNT AVE
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2624
Country	:	US
Telephone Number	:	410-494-0260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	04/12/2016

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Directions to “ AMINATA MANSARAY ” Practice Location

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