Provider Demographics
NPI:1164979662
Name:ASEKA, NGWENITA MAFOR NOELLA
Entity Type:Individual
Prefix:
First Name:NGWENITA
Middle Name:MAFOR NOELLA
Last Name:ASEKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NGWENITA
Other - Middle Name:MAFOR
Other - Last Name:NOELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:502 KENNEDY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3136
Mailing Address - Country:US
Mailing Address - Phone:202-313-7283
Mailing Address - Fax:
Practice Address - Street 1:4545 42ND ST NW STE 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:571-291-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 374U00000X
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017093157Medicaid