Provider Demographics
NPI:1679078000
Name:OROCK MANGET, ETHEL AGBOR
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:AGBOR
Last Name:OROCK MANGET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 DODGE PARK RD APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2110
Mailing Address - Country:US
Mailing Address - Phone:240-714-0952
Mailing Address - Fax:
Practice Address - Street 1:3307 DODGE PARK RD APT 202
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2110
Practice Address - Country:US
Practice Address - Phone:240-714-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13547374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide