Healthcare Provider Details

I. General information

NPI: 1720765217
Provider Name (Legal Business Name): SAMIRA KABIRU DANPOLLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 W SIDE BLVD APT 105
LAUREL MD
20707-6221
US

IV. Provider business mailing address

14140 W SIDE BLVD APT 105
LAUREL MD
20707-6221
US

V. Phone/Fax

Practice location:
  • Phone: 240-468-6165
  • Fax:
Mailing address:
  • Phone: 240-468-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHHA200002875
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: