Provider Demographics
NPI:1144585175
Name:NDIFOR, ELVIS ATANGACHE
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:ATANGACHE
Last Name:NDIFOR
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 1:4077 WARNER AVE
Mailing Address - Street 2:APT#08
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1947
Mailing Address - Country:US
Mailing Address - Phone:208-705-5163
Mailing Address - Fax:
Practice Address - Street 1:4077 WARNER AVE
Practice Address - Street 2:APT#08
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1947
Practice Address - Country:US
Practice Address - Phone:208-705-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide