Healthcare Provider Details

I. General information

NPI: 1588524276
Provider Name (Legal Business Name): MK NURSING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 MARTHAS CHOICE CIR
BOWIE MD
20720-4702
US

IV. Provider business mailing address

13101 MARTHAS CHOICE CIR
BOWIE MD
20720-4702
US

V. Phone/Fax

Practice location:
  • Phone: 240-604-1561
  • Fax:
Mailing address:
  • Phone: 240-604-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARIE LAURE NGOUMTSA ANOIZI
Title or Position: OWNER
Credential: RN
Phone: 240-604-1561