MEDICARE: ANNASTACIA NGANGA

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	374U00000X	Home Health Aide	759062	WA

General Provider Information

NPI Number	:	1710810312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNASTACIA NGANGA

Provider Business Mailing Address
First Line	:	533 RADEY ST
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3235
Country	:	US
Telephone Number	:	360-910-4413
Fax Number	:	360-443-2418

Provider Business Practice Location Address
First Line	:	533 RADEY ST
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3235
Country	:	US
Telephone Number	:	360-910-4413
Fax Number	:	360-443-2418

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ ANNASTACIA NGANGA ” Practice Location

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