Provider Demographics
NPI:1396261541
Name:ETI EPSE ACHA, NJANG NJANG
Entity type:Individual
Prefix:
First Name:NJANG
Middle Name:NJANG
Last Name:ETI EPSE ACHA
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 1:3512 54TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1004
Mailing Address - Country:US
Mailing Address - Phone:301-326-7691
Mailing Address - Fax:
Practice Address - Street 1:3512 54TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1004
Practice Address - Country:US
Practice Address - Phone:301-326-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-19
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13026374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC13026Medicaid