Provider Demographics
NPI:1972864965
Name:GONGA, NELSON BONGLACK (HHA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:BONGLACK
Last Name:GONGA
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12312 FEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7653
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:202-545-0934
Practice Address - Street 1:12312 FEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7653
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0934
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide