Provider Demographics
NPI:1346711777
Name:ELVIS, NKENGNANAG
Entity type:Individual
Prefix:MR
First Name:NKENGNANAG
Middle Name:
Last Name:ELVIS
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 1:4511 2ND ST NE APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4968
Mailing Address - Country:US
Mailing Address - Phone:202-415-2482
Mailing Address - Fax:
Practice Address - Street 1:1 BASS CIR SE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5136
Practice Address - Country:US
Practice Address - Phone:202-848-9847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4136527OtherDC DRIVERS LICENSE