MEDICARE: VICTORINE AKWEN NGANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN1041047	DC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R209034	MD

General Provider Information

NPI Number	:	1669930996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORINE AKWEN NGANG

Provider Business Mailing Address
First Line	:	6810 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-1641
Country	:	US
Telephone Number	:	443-538-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 PENNINGTON AVE
Second Line	:
City	:	CURTIS BAY
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	410-355-3285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	10/23/2020

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