Provider Demographics
NPI:1396007662
Name:NGUM, IMMACULATE
Entity Type:Individual
Prefix:
First Name:IMMACULATE
Middle Name:
Last Name:NGUM
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 1:13918 CASTLE BLVD
Mailing Address - Street 2:APT 304
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4954
Mailing Address - Country:US
Mailing Address - Phone:240-437-7099
Mailing Address - Fax:
Practice Address - Street 1:13918 CASTLE BLVD
Practice Address - Street 2:APT 304
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4954
Practice Address - Country:US
Practice Address - Phone:240-437-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide