Provider Demographics
NPI:1023550514
Name:CAROLINE, NGUM
Entity Type:Individual
Prefix:
First Name:NGUM
Middle Name:
Last Name:CAROLINE
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 1:3202 TOLEDO PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4113
Mailing Address - Country:US
Mailing Address - Phone:240-714-7175
Mailing Address - Fax:
Practice Address - Street 1:3202 TOLEDO PL
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4113
Practice Address - Country:US
Practice Address - Phone:240-714-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12148374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide