Provider Demographics
NPI:1760768618
Name:NDESOH, ELVIS
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:NDESOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 KIRKWOOD PL APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2640
Mailing Address - Country:US
Mailing Address - Phone:301-915-6067
Mailing Address - Fax:301-915-6067
Practice Address - Street 1:2714 KIRKWOOD PL APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2640
Practice Address - Country:US
Practice Address - Phone:301-915-6067
Practice Address - Fax:301-915-6067
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC163WH0200X163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health