Provider Demographics
NPI:1225399140
Name:NGWESE, SUSAN EHODE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EHODE
Last Name:NGWESE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 LANDOVER RD APT 104
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1419
Mailing Address - Country:US
Mailing Address - Phone:202-483-2657
Mailing Address - Fax:
Practice Address - Street 1:6509 LANDOVER RD APT 104
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1419
Practice Address - Country:US
Practice Address - Phone:202-483-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCN221201806363LP0808X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health