Provider Demographics
NPI:1689256687
Name:NGO NDOUMI, BERTHE A
Entity Type:Individual
Prefix:
First Name:BERTHE
Middle Name:A
Last Name:NGO NDOUMI
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 1:10409 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1225
Mailing Address - Country:US
Mailing Address - Phone:240-470-8420
Mailing Address - Fax:
Practice Address - Street 1:10409 FLORAL DR
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1225
Practice Address - Country:US
Practice Address - Phone:240-470-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide