Provider Demographics
NPI:1609341312
Name:ATEAWUNG, NGENYI
Entity Type:Individual
Prefix:
First Name:NGENYI
Middle Name:
Last Name:ATEAWUNG
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 1:3404 DODGE PARK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2011
Mailing Address - Country:US
Mailing Address - Phone:240-696-9622
Mailing Address - Fax:
Practice Address - Street 1:821 KENNEDY ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2913
Practice Address - Country:US
Practice Address - Phone:202-722-1725
Practice Address - Fax:202-722-1726
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide