Provider Demographics
NPI:1508541244
Name:NYINDEM, NGU
Entity Type:Individual
Prefix:
First Name:NGU
Middle Name:
Last Name:NYINDEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 DONEGAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-8236
Mailing Address - Country:US
Mailing Address - Phone:703-298-3429
Mailing Address - Fax:
Practice Address - Street 1:7960 DONEGAN DR STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-8236
Practice Address - Country:US
Practice Address - Phone:703-298-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8243-03-011253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care