Provider Demographics
NPI:1669930996
Name:NGANG, VICTORINE AKWEN
Entity type:Individual
Prefix:
First Name:VICTORINE
Middle Name:AKWEN
Last Name:NGANG
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 1:6810 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1641
Mailing Address - Country:US
Mailing Address - Phone:443-538-8400
Mailing Address - Fax:
Practice Address - Street 1:4710 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:CURTIS BAY
Practice Address - State:MD
Practice Address - Zip Code:21226-1405
Practice Address - Country:US
Practice Address - Phone:410-355-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1041047363LP0808X
MDR209034363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health