Provider Demographics
NPI:1184986788
Name:NIBA, JOSEPHINE AWOUNFAC NGUM
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:AWOUNFAC NGUM
Last Name:NIBA
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 1:8436 RAVENSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2728
Mailing Address - Country:US
Mailing Address - Phone:410-330-5577
Mailing Address - Fax:
Practice Address - Street 1:8436 RAVENSWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-2728
Practice Address - Country:US
Practice Address - Phone:410-330-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide