Provider Demographics
NPI:1538877907
Name:NGWANG, BRENDA K
Entity type:Individual
Prefix:
First Name:BRENDA K
Middle Name:
Last Name:NGWANG
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 1:6815 RIVERDALE RD APT F2
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1811
Mailing Address - Country:US
Mailing Address - Phone:803-269-4985
Mailing Address - Fax:
Practice Address - Street 1:6815 RIVERDALE RD APT F2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1811
Practice Address - Country:US
Practice Address - Phone:803-269-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide