Provider Demographics
NPI:1558016832
Name:NGUEFACK, JOSUE (NP)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:NGUEFACK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 FALLEN TIMBERS CIR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1083
Mailing Address - Country:US
Mailing Address - Phone:240-281-6177
Mailing Address - Fax:
Practice Address - Street 1:12104 FALLEN TIMBERS CIR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1083
Practice Address - Country:US
Practice Address - Phone:240-281-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health