Provider Demographics
NPI:1144580366
Name:NGUTI, LEONARD NGWA
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:NGWA
Last Name:NGUTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 MATHEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3003
Mailing Address - Country:US
Mailing Address - Phone:585-360-8445
Mailing Address - Fax:
Practice Address - Street 1:7018 MATHEW ST
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3003
Practice Address - Country:US
Practice Address - Phone:585-360-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2894221374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide