Provider Demographics
NPI:1336815802
Name:NGONGWASHI, PROMISE LUM (MSN-PMHNP)
Entity type:Individual
Prefix:MRS
First Name:PROMISE
Middle Name:LUM
Last Name:NGONGWASHI
Suffix:
Gender:F
Credentials:MSN-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 PISCATAWAY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3630
Mailing Address - Country:US
Mailing Address - Phone:240-965-1715
Mailing Address - Fax:240-965-1716
Practice Address - Street 1:9314 PISCATAWAY RD STE 250
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3630
Practice Address - Country:US
Practice Address - Phone:240-965-1715
Practice Address - Fax:240-965-1716
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1044901363LP0808X
MDR236187363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health