Provider Demographics
NPI:1740099704
Name:NYASA GANGNI, EMMANUEL (N/A)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:NYASA GANGNI
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:MR
Other - First Name:EMMANUEL
Other - Middle Name:
Other - Last Name:NYASA GANGNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:2020 BRIGADIER BLVD
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1038
Mailing Address - Country:US
Mailing Address - Phone:240-498-4466
Mailing Address - Fax:
Practice Address - Street 1:702 15TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4508
Practice Address - Country:US
Practice Address - Phone:240-498-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker