Provider Demographics
NPI:1992136642
Name:NGAHANE NYA, GAEL JOSIANE
Entity type:Individual
Prefix:
First Name:GAEL JOSIANE
Middle Name:
Last Name:NGAHANE NYA
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 1:702 GORMAN AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3948
Mailing Address - Country:US
Mailing Address - Phone:240-264-7278
Mailing Address - Fax:
Practice Address - Street 1:702 GORMAN AVE
Practice Address - Street 2:APT 103
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3948
Practice Address - Country:US
Practice Address - Phone:240-264-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide