Healthcare Provider Details

I. General information

NPI: 1295502144
Provider Name (Legal Business Name): MAURINE Z NJONGUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 E MARLBORO AVE APT 102
HYATTSVILLE MD
20785-5235
US

IV. Provider business mailing address

2102 E MARLBORO AVE APT 102
HYATTSVILLE MD
20785-5235
US

V. Phone/Fax

Practice location:
  • Phone: 402-405-9265
  • Fax:
Mailing address:
  • Phone: 402-405-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: