Provider Demographics
NPI:1215280474
Name:BISONG, NELSON NKENGAFAC
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:NKENGAFAC
Last Name:BISONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1828
Mailing Address - Country:US
Mailing Address - Phone:240-413-7978
Mailing Address - Fax:
Practice Address - Street 1:3821 64TH AVE
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1828
Practice Address - Country:US
Practice Address - Phone:240-413-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB-252626632835374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide