Provider Demographics
NPI:1225549660
Name:NGAMBY, TATIANA ADDEGONE I
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:ADDEGONE
Last Name:NGAMBY
Suffix:I
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 1:4273 58TH AVE APT T2
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1967
Mailing Address - Country:US
Mailing Address - Phone:240-688-2519
Mailing Address - Fax:
Practice Address - Street 1:4273 58TH AVE APT T2
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1967
Practice Address - Country:US
Practice Address - Phone:240-688-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHHA13168374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty