Provider Demographics
NPI:1861013435
Name:NGUFOR, BERT DESTINY T
Entity Type:Individual
Prefix:
First Name:BERT DESTINY
Middle Name:T
Last Name:NGUFOR
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 1:3223 75TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1914
Mailing Address - Country:US
Mailing Address - Phone:469-989-2082
Mailing Address - Fax:
Practice Address - Street 1:3223 75TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-1914
Practice Address - Country:US
Practice Address - Phone:469-989-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide