Provider Demographics
NPI:1255690251
Name:NGULEFAC, QUEENTA ASONGAKENG
Entity Type:Individual
Prefix:
First Name:QUEENTA
Middle Name:ASONGAKENG
Last Name:NGULEFAC
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 1:3710 ANGELTON CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2052
Mailing Address - Country:US
Mailing Address - Phone:301-524-2026
Mailing Address - Fax:301-890-3557
Practice Address - Street 1:3710 ANGELTON CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2052
Practice Address - Country:US
Practice Address - Phone:301-524-2026
Practice Address - Fax:301-890-3557
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide