Provider Demographics
NPI:1497420129
Name:CALDERON, NOUNGUIM VIRGINIA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NOUNGUIM
Middle Name:VIRGINIA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18125 HOMELAND DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1792
Mailing Address - Country:US
Mailing Address - Phone:240-483-7364
Mailing Address - Fax:
Practice Address - Street 1:18125 HOMELAND DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1792
Practice Address - Country:US
Practice Address - Phone:240-483-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF05210848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily