Provider Demographics
NPI:1689229551
Name:NKENGAWUNG BLANCHE, NKENG FONJI
Entity Type:Individual
Prefix:
First Name:NKENG FONJI
Middle Name:
Last Name:NKENGAWUNG BLANCHE
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 1:7611 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3750
Mailing Address - Country:US
Mailing Address - Phone:803-743-8880
Mailing Address - Fax:
Practice Address - Street 1:7611 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3750
Practice Address - Country:US
Practice Address - Phone:803-743-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide