Provider Demographics
NPI:1871009472
Name:SUH, IRENE NGWEN
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:NGWEN
Last Name:SUH
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 1:7609 RIVERDALE RD APT 325
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3748
Mailing Address - Country:US
Mailing Address - Phone:240-645-2041
Mailing Address - Fax:
Practice Address - Street 1:7609 RIVERDALE RD APT 325
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3748
Practice Address - Country:US
Practice Address - Phone:240-645-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13330374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide