Provider Demographics
NPI:1194091504
Name:BESONG, GLORY L (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:GLORY
Middle Name:L
Last Name:BESONG
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 CATSKILL ST # 2
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4029
Mailing Address - Country:US
Mailing Address - Phone:301-728-2534
Mailing Address - Fax:
Practice Address - Street 1:3575 CATSKILL ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4029
Practice Address - Country:US
Practice Address - Phone:301-728-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN500013625163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health