Provider Demographics
NPI:1568848695
Name:NGWENYI, EMERENCIA
Entity Type:Individual
Prefix:
First Name:EMERENCIA
Middle Name:
Last Name:NGWENYI
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 1:3407 DODGE PARK RD APT 202
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2017
Mailing Address - Country:US
Mailing Address - Phone:240-413-9202
Mailing Address - Fax:
Practice Address - Street 1:3407 DODGE PARK RD APT 202
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2017
Practice Address - Country:US
Practice Address - Phone:240-413-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11385390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program