Provider Demographics
NPI:1205196623
Name:NOUNGWA, EDWIGE MBIAKEU
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:MBIAKEU
Last Name:NOUNGWA
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 1:2831 HARRISON CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3907
Mailing Address - Country:US
Mailing Address - Phone:240-551-1267
Mailing Address - Fax:
Practice Address - Street 1:2831 HARRISON CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3907
Practice Address - Country:US
Practice Address - Phone:240-551-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide