MEDICARE: EMILIENNE NGO MANYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	A00193705	MD
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1639779531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIENNE NGO MANYO

Provider Business Mailing Address
First Line	:	604 10TH ST
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 RICHMOND HWY STE 700
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4016
Country	:	US
Telephone Number	:	844-381-4432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	08/05/2021

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Directions to “ EMILIENNE NGO MANYO ” Practice Location

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