Provider Demographics
NPI:1124471081
Name:ESSIEN, AFFIONG
Entity type:Individual
Prefix:
First Name:AFFIONG
Middle Name:
Last Name:ESSIEN
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 1:4 TEMPLAR CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1047
Mailing Address - Country:US
Mailing Address - Phone:240-481-4101
Mailing Address - Fax:
Practice Address - Street 1:4 TEMPLAR CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1047
Practice Address - Country:US
Practice Address - Phone:240-481-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN8480164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse