Provider Demographics
NPI:1316526171
Name:NGWA, VANESSA BINWI (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:BINWI
Last Name:NGWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11407 VILLA CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5702
Mailing Address - Country:US
Mailing Address - Phone:240-706-6054
Mailing Address - Fax:
Practice Address - Street 1:11407 VILLA CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5702
Practice Address - Country:US
Practice Address - Phone:240-706-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN200839089445163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN200839089445Medicaid