Provider Demographics
NPI:1063225142
Name:NDUM, BASIL TEGHEN (RN)
Entity type:Individual
Prefix:MR
First Name:BASIL
Middle Name:TEGHEN
Last Name:NDUM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3044
Mailing Address - Country:US
Mailing Address - Phone:240-872-6598
Mailing Address - Fax:
Practice Address - Street 1:9105 JOUSTING LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4388
Practice Address - Country:US
Practice Address - Phone:240-872-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001301762163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator