Provider Demographics
NPI:1538655634
Name:GHOGOMU, PAMELA S
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:GHOGOMU
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 1:515 THAYER AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5367
Mailing Address - Country:US
Mailing Address - Phone:202-431-9058
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW STE 320A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN961003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse