Provider Demographics
NPI:1164767315
Name:NGUFOR, ALICE TENDONGMOA
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:TENDONGMOA
Last Name:NGUFOR
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 1:3807 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1814
Mailing Address - Country:US
Mailing Address - Phone:240-413-6967
Mailing Address - Fax:
Practice Address - Street 1:3807 64TH AVE
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1814
Practice Address - Country:US
Practice Address - Phone:240-413-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide