Healthcare Provider Details

I. General information

NPI: 1740782358
Provider Name (Legal Business Name): MAUREEN BEJANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23304 RAINBOW ARCH DR
CLARKSBURG MD
20871-4449
US

IV. Provider business mailing address

23304 RAINBOW ARCH DR
CLARKSBURG MD
20871-4449
US

V. Phone/Fax

Practice location:
  • Phone: 240-605-5582
  • Fax: 301-972-1768
Mailing address:
  • Phone: 240-605-5582
  • Fax: 301-972-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR166873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: