Provider Demographics
NPI:1497206379
Name:NGONGMON, QUEENTA
Entity Type:Individual
Prefix:
First Name:QUEENTA
Middle Name:
Last Name:NGONGMON
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 1:9314 CHERRY HILL RD APT 815
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1252
Mailing Address - Country:US
Mailing Address - Phone:240-281-8387
Mailing Address - Fax:
Practice Address - Street 1:9314 CHERRY HILL RD APT 815
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1252
Practice Address - Country:US
Practice Address - Phone:240-281-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11690374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide