Provider Demographics
NPI:1932671989
Name:NGUNGWA, NCHWIMEH SEROPHINE
Entity Type:Individual
Prefix:
First Name:NCHWIMEH
Middle Name:SEROPHINE
Last Name:NGUNGWA
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 1:6817 WOODSTREAM CIR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2133
Mailing Address - Country:US
Mailing Address - Phone:240-471-5330
Mailing Address - Fax:
Practice Address - Street 1:6817 WOODSTREAM CIR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2133
Practice Address - Country:US
Practice Address - Phone:240-471-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14161374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide