Healthcare Provider Details

I. General information

NPI: 1578401683
Provider Name (Legal Business Name): MIRABEL A NYANGDONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 GRENFELL CT
BOWIE MD
20720-5331
US

IV. Provider business mailing address

6301 GRENFELL CT
BOWIE MD
20720-5331
US

V. Phone/Fax

Practice location:
  • Phone: 240-923-6889
  • Fax:
Mailing address:
  • Phone: 240-923-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: