Provider Demographics
NPI:1063905529
Name:OPPONG, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OPPONG
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 1:2302 CAMPUS WAY N
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1858
Mailing Address - Country:US
Mailing Address - Phone:240-646-2877
Mailing Address - Fax:
Practice Address - Street 1:2939 VAN NESS ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4662
Practice Address - Country:US
Practice Address - Phone:240-646-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide