Healthcare Provider Details

I. General information

NPI: 1851185425
Provider Name (Legal Business Name): MARIE ANGELIQUE RUGANGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21067 STANFORD SQ APT 201
STERLING VA
20166-2463
US

IV. Provider business mailing address

21067 STANFORD SQ APT 201
STERLING VA
20166-2463
US

V. Phone/Fax

Practice location:
  • Phone: 202-550-3492
  • Fax:
Mailing address:
  • Phone: 202-550-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401204642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: