Provider Demographics
NPI:1780931899
Name:NGOH, CORETTA AMBUCK
Entity type:Individual
Prefix:MISS
First Name:CORETTA
Middle Name:AMBUCK
Last Name:NGOH
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 1:9100 SPRINGHILL LN
Mailing Address - Street 2:APT 104
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1223
Mailing Address - Country:US
Mailing Address - Phone:318-278-5009
Mailing Address - Fax:
Practice Address - Street 1:9100 SPRINGHILL LN
Practice Address - Street 2:APT 104
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1223
Practice Address - Country:US
Practice Address - Phone:318-278-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide