Provider Demographics
NPI:1952755050
Name:NGOGNONG, MOUOPE ROSALINE
Entity type:Individual
Prefix:
First Name:MOUOPE ROSALINE
Middle Name:
Last Name:NGOGNONG
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 1:3400 DODGE PARK RD
Mailing Address - Street 2:201
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2001
Mailing Address - Country:US
Mailing Address - Phone:646-284-4164
Mailing Address - Fax:
Practice Address - Street 1:3400 DODGE PARK RD
Practice Address - Street 2:201
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2001
Practice Address - Country:US
Practice Address - Phone:646-284-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DCHHA11810374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator