Provider Demographics
NPI:1508580697
Name:TEBONG NEE NGWANYI, GLADYS VARIM
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:VARIM
Last Name:TEBONG NEE NGWANYI
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 1:10110 MOLECULAR DR STE 114
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7538
Mailing Address - Country:US
Mailing Address - Phone:301-780-4745
Mailing Address - Fax:301-605-7550
Practice Address - Street 1:10110 MOLECULAR DR STE 114
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7538
Practice Address - Country:US
Practice Address - Phone:301-780-4745
Practice Address - Fax:301-605-7550
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG09220100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care