Provider Demographics
NPI:1508378159
Name:NDUNGMBOWO, TESSI (HOME HEALTH AID)
Entity Type:Individual
Prefix:
First Name:TESSI
Middle Name:
Last Name:NDUNGMBOWO
Suffix:
Gender:M
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 STEWART LN APT 607
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2254
Mailing Address - Country:US
Mailing Address - Phone:240-481-7522
Mailing Address - Fax:
Practice Address - Street 1:11550 STEWART LN APT 607
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2254
Practice Address - Country:US
Practice Address - Phone:240-481-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HHA13152374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide