Provider Demographics
NPI:1083483796
Name:FON NGUM, MINETT
Entity Type:Individual
Prefix:
First Name:MINETT
Middle Name:
Last Name:FON NGUM
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 1:6704 W FOREST RD APT 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3312
Mailing Address - Country:US
Mailing Address - Phone:240-501-0143
Mailing Address - Fax:
Practice Address - Street 1:6704 W FOREST RD APT 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-3312
Practice Address - Country:US
Practice Address - Phone:240-501-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide