Provider Demographics
NPI:1356904122
Name:NGANGA, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:NGANGA
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 1:1017 SHILO ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-3284
Mailing Address - Country:US
Mailing Address - Phone:267-252-1436
Mailing Address - Fax:
Practice Address - Street 1:1017 SHILO ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-3284
Practice Address - Country:US
Practice Address - Phone:267-252-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA35973601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036051780001Medicaid