Provider Demographics
NPI:1538427083
Name:NGANGUM, MARCELLINE K (BACHELOR DEGREE)
Entity type:Individual
Prefix:MRS
First Name:MARCELLINE
Middle Name:K
Last Name:NGANGUM
Suffix:
Gender:F
Credentials:BACHELOR DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13817 CASTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7336
Mailing Address - Country:US
Mailing Address - Phone:301-850-2579
Mailing Address - Fax:301-476-4532
Practice Address - Street 1:13817 CASTLE BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7336
Practice Address - Country:US
Practice Address - Phone:301-850-2579
Practice Address - Fax:301-476-4532
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7274374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA7274Medicaid