Provider Demographics
NPI:1558809012
Name:NTONGHANWAH, NGUNKENG NCHINDIA (RN)
Entity Type:Individual
Prefix:
First Name:NGUNKENG
Middle Name:NCHINDIA
Last Name:NTONGHANWAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SADDLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4162
Mailing Address - Country:US
Mailing Address - Phone:703-909-5110
Mailing Address - Fax:
Practice Address - Street 1:205 SADDLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-4162
Practice Address - Country:US
Practice Address - Phone:703-909-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1018009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse