Healthcare Provider Details

I. General information

NPI: 1497585749
Provider Name (Legal Business Name): DR. BLANCHE MUTO MAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W EDMONSTON DR STE 404
ROCKVILLE MD
20852-1274
US

IV. Provider business mailing address

3708 LAMBERTON SQUARE RD APT 1534
SILVER SPRING MD
20904-7734
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-7723
  • Fax:
Mailing address:
  • Phone: 240-606-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201425
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: