Provider Demographics
NPI:1083100903
Name:NGWA, SOLANGE LUM
Entity Type:Individual
Prefix:
First Name:SOLANGE
Middle Name:LUM
Last Name:NGWA
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 1:3801 KENILWORTH AVE APT 401E
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2146
Mailing Address - Country:US
Mailing Address - Phone:202-527-8002
Mailing Address - Fax:301-339-4396
Practice Address - Street 1:3801 KENILWORTH AVE APT 401E
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710
Practice Address - Country:US
Practice Address - Phone:202-527-8002
Practice Address - Fax:301-339-4396
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide