Provider Demographics
NPI:1174005813
Name:FONGANG, AKUM RELINDISE
Entity Type:Individual
Prefix:
First Name:AKUM
Middle Name:RELINDISE
Last Name:FONGANG
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 1:3510 HUBBARD RD APT 304
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2080
Mailing Address - Country:US
Mailing Address - Phone:240-360-6641
Mailing Address - Fax:
Practice Address - Street 1:3510 HUBBARD RD APT 304
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2080
Practice Address - Country:US
Practice Address - Phone:240-360-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13937374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide