Provider Demographics
NPI:1598488702
Name:IJANG, BRIDGET MONGOH
Entity Type:Individual
Prefix:
First Name:BRIDGET MONGOH
Middle Name:
Last Name:IJANG
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 1:9787 GOOD LUCK RD APT 13
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3342
Mailing Address - Country:US
Mailing Address - Phone:301-454-9860
Mailing Address - Fax:
Practice Address - Street 1:9787 GOOD LUCK RD APT 13
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3342
Practice Address - Country:US
Practice Address - Phone:301-454-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide