Provider Demographics
NPI:1023606928
Name:NELLY, AKONDENG
Entity type:Individual
Prefix:
First Name:AKONDENG
Middle Name:
Last Name:NELLY
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 1:8608 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1910
Mailing Address - Country:US
Mailing Address - Phone:443-454-5209
Mailing Address - Fax:
Practice Address - Street 1:8608 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1910
Practice Address - Country:US
Practice Address - Phone:443-454-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000812784374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide