Provider Demographics
NPI:1649665662
Name:NTWISI, NGUM
Entity type:Individual
Prefix:
First Name:NGUM
Middle Name:
Last Name:NTWISI
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 1:13908 CASTLE BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4945
Mailing Address - Country:US
Mailing Address - Phone:240-704-0869
Mailing Address - Fax:
Practice Address - Street 1:13908 CASTLE BLVD APT 304
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4945
Practice Address - Country:US
Practice Address - Phone:240-704-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11184374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide