Provider Information for 1548929664
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NWANDO MARY OLISA
Sex: Female
NPI: 1548929664
Last Updated: 2021-12-16
Certification Date: 2021-12-16
Certification Date: 2021-12-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1548929664 | ||||||||
| Enumeration Date | 2021-12-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 702 RUSSELL AVE STE 100 GAITHERSBURG, MD 20877-2605 United States Phone: 301-330-0006 | Fax: | ||||||||
| Primary Practice Address | 702 RUSSELL AVE STE 100 GAITHERSBURG, MD 20877-2605 United States Phone: 301-330-0006 | Fax: | ||||||||
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