Provider Demographics
NPI:1528569241
Name:NJUGUNA, DELPHINE GATHONI
Entity Type:Individual
Prefix:MS
First Name:DELPHINE
Middle Name:GATHONI
Last Name:NJUGUNA
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 1:4509 BLACKBIRDS FOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5803
Mailing Address - Country:US
Mailing Address - Phone:770-882-7453
Mailing Address - Fax:
Practice Address - Street 1:4509 BLACKBIRDS FOLLY LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5803
Practice Address - Country:US
Practice Address - Phone:770-882-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD433904224P00000X
MD5000180317224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8239344786OtherDELPHINES BEAUTY PARLOR