Provider Demographics
NPI:1740814375
Name:FONJANG, NAYAH FELICIA
Entity type:Individual
Prefix:
First Name:NAYAH
Middle Name:FELICIA
Last Name:FONJANG
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 1:11235 OAK LEAF DR APT 419
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1332
Mailing Address - Country:US
Mailing Address - Phone:301-232-7106
Mailing Address - Fax:
Practice Address - Street 1:11235 OAK LEAF DR APT 419
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1332
Practice Address - Country:US
Practice Address - Phone:301-232-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15194374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide