Provider Demographics
NPI:1902166861
Name:NGWANGUNG, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NGWANGUNG
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 1:15763 POINTER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1710
Mailing Address - Country:US
Mailing Address - Phone:240-421-8032
Mailing Address - Fax:
Practice Address - Street 1:15763 POINTER RIDGE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1710
Practice Address - Country:US
Practice Address - Phone:240-421-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN252734002002374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide