Provider Demographics
NPI:1619512894
Name:NGWA, MISTERINE LUM
Entity Type:Individual
Prefix:
First Name:MISTERINE
Middle Name:LUM
Last Name:NGWA
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 1:2328 BRIGHTSEAT RD APT 3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3539
Mailing Address - Country:US
Mailing Address - Phone:202-415-4797
Mailing Address - Fax:
Practice Address - Street 1:2504 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3646
Practice Address - Country:US
Practice Address - Phone:202-415-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14735374U00000X
374U00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide