Provider Demographics
NPI:1356660740
Name:NGONGBO, ELIZABETH-JANE MENGWI (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH-JANE
Middle Name:MENGWI
Last Name:NGONGBO
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4405
Mailing Address - Country:US
Mailing Address - Phone:703-361-4357
Mailing Address - Fax:703-361-0346
Practice Address - Street 1:9009 SILVERBROOK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2607
Practice Address - Country:US
Practice Address - Phone:703-493-8531
Practice Address - Fax:703-361-0346
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001202623163W00000X
VA0024169666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse