Provider Demographics
NPI:1902561988
Name:GONGS, TAWANDA RENEA
Entity Type:Individual
Prefix:
First Name:TAWANDA
Middle Name:RENEA
Last Name:GONGS
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 1:1842 PROVIDENCE ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1770
Mailing Address - Country:US
Mailing Address - Phone:202-705-6227
Mailing Address - Fax:
Practice Address - Street 1:1842 PROVIDENCE ST NE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1770
Practice Address - Country:US
Practice Address - Phone:202-705-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant