Provider Demographics
NPI:1033479639
Name:TIKUM, NYANGA GENEVIEVE
Entity Type:Individual
Prefix:
First Name:NYANGA
Middle Name:GENEVIEVE
Last Name:TIKUM
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 1:2200 PHELPS RD APT 207
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4425
Mailing Address - Country:US
Mailing Address - Phone:301-335-8565
Mailing Address - Fax:
Practice Address - Street 1:2200 PHELPS RD APT 207
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-4425
Practice Address - Country:US
Practice Address - Phone:301-335-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide