Provider Demographics
NPI:1174017123
Name:NGONG, NJODZEKA VENATIUS (DNP,CRNA)
Entity Type:Individual
Prefix:DR
First Name:NJODZEKA
Middle Name:VENATIUS
Last Name:NGONG
Suffix:
Gender:M
Credentials:DNP,CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 4TH STREET
Mailing Address - Street 2:C/O ELSIE EVAKISE
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:281-413-4054
Mailing Address - Fax:
Practice Address - Street 1:251 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1375
Practice Address - Country:US
Practice Address - Phone:301-533-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002337367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered