Provider Demographics
NPI:1780013003
Name:CHWEFUNG, NICHOLINE A
Entity type:Individual
Prefix:
First Name:NICHOLINE
Middle Name:A
Last Name:CHWEFUNG
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 1:8703 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3918
Mailing Address - Country:US
Mailing Address - Phone:240-602-2789
Mailing Address - Fax:
Practice Address - Street 1:3500 HUBBARD RD APT 102
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2058
Practice Address - Country:US
Practice Address - Phone:443-204-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA10007251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health