Provider Demographics
NPI:1013279983
Name:ASIMA, GWENDOLINE ETONDE
Entity Type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:ETONDE
Last Name:ASIMA
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 1:6909 PRESLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3463
Mailing Address - Country:US
Mailing Address - Phone:301-357-4103
Mailing Address - Fax:
Practice Address - Street 1:6909 PRESLEY RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3463
Practice Address - Country:US
Practice Address - Phone:301-357-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide