Provider Demographics
NPI:1366970196
Name:NGUFOR, NERISSA NKANGU
Entity type:Individual
Prefix:
First Name:NERISSA
Middle Name:NKANGU
Last Name:NGUFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 MENTANA ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3505
Mailing Address - Country:US
Mailing Address - Phone:240-413-1608
Mailing Address - Fax:
Practice Address - Street 1:5822 MENTANA ST
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3505
Practice Address - Country:US
Practice Address - Phone:240-413-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12767374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide