MEDICARE: MARLENE TSHIBANGU

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	367500000X	Certified Registered Nurse Anesthetist	A00196191	MD
2	374U00000X	Home Health Aide	A00196191	MD

General Provider Information

NPI Number	:	1811642796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE TSHIBANGU

Provider Business Mailing Address
First Line	:	7602 FONTAINEBLEAU DR APT 242
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3812
Country	:	US
Telephone Number	:	202-247-8194
Fax Number	:

Provider Business Practice Location Address
First Line	:	7602 FONTAINEBLEAU DR APT 242
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3812
Country	:	US
Telephone Number	:	202-247-8194
Fax Number	:

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

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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Directions to “ MARLENE TSHIBANGU ” Practice Location

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