Provider Demographics
NPI:1811571326
Name:ANDONG, ELECTA
Entity Type:Individual
Prefix:
First Name:ELECTA
Middle Name:
Last Name:ANDONG
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 1:16402 EURO CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3903
Mailing Address - Country:US
Mailing Address - Phone:240-639-6579
Mailing Address - Fax:
Practice Address - Street 1:16402 EURO CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3903
Practice Address - Country:US
Practice Address - Phone:240-639-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide