Provider Demographics
NPI:1528428778
Name:BIMNENUI PHONJAM NGU, UNKNOWN
Entity type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:BIMNENUI PHONJAM NGU
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 1:8110 LOCKNEY AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7404
Mailing Address - Country:US
Mailing Address - Phone:301-755-8376
Mailing Address - Fax:
Practice Address - Street 1:8110 LOCKNEY AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7404
Practice Address - Country:US
Practice Address - Phone:301-755-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11728374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide