Provider Demographics
NPI:1649906058
Name:NWELA, ESTHER NGO NTOMB
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:NGO NTOMB
Last Name:NWELA
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 1:8957 EDMONSTON RD STE P
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4048
Mailing Address - Country:US
Mailing Address - Phone:410-696-1989
Mailing Address - Fax:
Practice Address - Street 1:8957 EDMONSTON RD STE P
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4048
Practice Address - Country:US
Practice Address - Phone:410-696-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00060948376K00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11176675090Medicaid