Provider Demographics
NPI:1144640087
Name:WILSON, MARY MANINGUE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MANINGUE
Last Name:WILSON
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 1:9365 STEEPLE CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5822
Mailing Address - Country:US
Mailing Address - Phone:301-362-9754
Mailing Address - Fax:
Practice Address - Street 1:9365 STEEPLE CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5822
Practice Address - Country:US
Practice Address - Phone:301-362-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide