Provider Demographics
NPI:1669808093
Name:ATONGWE, MELVIS A
Entity type:Individual
Prefix:MS
First Name:MELVIS
Middle Name:A
Last Name:ATONGWE
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 1:6714 HAVENOAK RD
Mailing Address - Street 2:APT. A4
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2179
Mailing Address - Country:US
Mailing Address - Phone:443-579-6138
Mailing Address - Fax:
Practice Address - Street 1:6714 HAVENOAK RD
Practice Address - Street 2:APT. A4
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2179
Practice Address - Country:US
Practice Address - Phone:443-579-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide