Provider Demographics
NPI:1619479193
Name:BENGA, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BENGA
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 1:5821 CHERRY WOOD LN APT 104 5821 CHERRY WOOD LN APT 104
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1266
Mailing Address - Country:US
Mailing Address - Phone:240-453-1172
Mailing Address - Fax:
Practice Address - Street 1:5821 CHERRYWOOD LN APT 104 5821 CHERRY WOOD LN APT 104
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:240-453-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB520622014417OtherNANCY BENGA
MDB520622014417OtherDL