Provider Demographics
NPI:1871901173
Name:SONE, MARY TOMBISE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:TOMBISE
Last Name:SONE
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 1:8805 BARNSLEY CT APT 22
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3477
Mailing Address - Country:US
Mailing Address - Phone:407-437-4881
Mailing Address - Fax:
Practice Address - Street 1:8805 BARNSLEY CT APT 22
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3477
Practice Address - Country:US
Practice Address - Phone:407-437-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10386251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26233499Medicaid