Provider Demographics
NPI:1568902781
Name:NGUAFAC, IRENE NKEZE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:NKEZE
Last Name:NGUAFAC
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 1:3419 DODGE PARK RD
Mailing Address - Street 2:APT 201
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2041
Mailing Address - Country:US
Mailing Address - Phone:240-467-0101
Mailing Address - Fax:
Practice Address - Street 1:3419 DODGE PARK RD
Practice Address - Street 2:APT 201
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2041
Practice Address - Country:US
Practice Address - Phone:240-467-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12797374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide