Provider Demographics
NPI:1215372180
Name:NCHANGNWIE, DILYS FORSUH
Entity Type:Individual
Prefix:
First Name:DILYS
Middle Name:FORSUH
Last Name:NCHANGNWIE
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 1:2001 TREETOP LN APT 31
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7679
Mailing Address - Country:US
Mailing Address - Phone:240-476-0718
Mailing Address - Fax:
Practice Address - Street 1:2001 TREETOP LN APT 31
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7679
Practice Address - Country:US
Practice Address - Phone:240-478-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA5480251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD44504789000Medicaid