Provider Demographics
NPI:1316581556
Name:FONGANG, BOUDAUN ABIT (HHA)
Entity Type:Individual
Prefix:
First Name:BOUDAUN
Middle Name:ABIT
Last Name:FONGANG
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 TEAGARDEN CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7518
Mailing Address - Country:US
Mailing Address - Phone:240-353-9439
Mailing Address - Fax:
Practice Address - Street 1:3323 TEAGARDEN CIR APT 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7518
Practice Address - Country:US
Practice Address - Phone:240-353-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14718374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide