Provider Demographics
NPI:1962105569
Name:MEGACHE ESPE NGANSOP, ALICE
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:MEGACHE ESPE NGANSOP
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:MEGACHE ESPE NGANSOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11215 OAK LEAF DR APT 418
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1367
Mailing Address - Country:US
Mailing Address - Phone:202-940-3605
Mailing Address - Fax:
Practice Address - Street 1:11215 OAK LEAF DR APT 418
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1367
Practice Address - Country:US
Practice Address - Phone:202-940-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A00205881374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide