Provider Demographics
NPI:1558609206
Name:FONGYEN, GLADYS N (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:N
Last Name:FONGYEN
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MILLPORT LANE #233
Mailing Address - Street 2:SALISBURY MD 21804
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-845-6587
Mailing Address - Fax:
Practice Address - Street 1:304 MILL POND LN APT 233
Practice Address - Street 2:SALISBURY MD 21804
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2126
Practice Address - Country:US
Practice Address - Phone:410-845-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide