Healthcare Provider Details

I. General information

NPI: 1275464752
Provider Name (Legal Business Name): MARIE YVANNA NGO NKOYOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 PALMER PARK RD
HYATTSVILLE MD
20785-4144
US

IV. Provider business mailing address

1934 PALMER PARK RD
HYATTSVILLE MD
20785-4144
US

V. Phone/Fax

Practice location:
  • Phone: 240-960-1310
  • Fax:
Mailing address:
  • Phone: 240-960-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA200006385
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: