Provider Demographics
NPI:1407479629
Name:TCHANGA, LIONELLE A
Entity Type:Individual
Prefix:
First Name:LIONELLE
Middle Name:A
Last Name:TCHANGA
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 1:258 HARRY S TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2022
Mailing Address - Country:US
Mailing Address - Phone:301-433-2284
Mailing Address - Fax:
Practice Address - Street 1:258 HARRY S TRUMAN DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-2022
Practice Address - Country:US
Practice Address - Phone:301-433-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00184509376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide