Healthcare Provider Details

I. General information

NPI: 1417507203
Provider Name (Legal Business Name): MR. NELSON NGWA BALINGWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 BENNING RD NE
WASHINGTON DC
20019-1502
US

IV. Provider business mailing address

3341 BENNING RD NE
WASHINGTON DC
20019-1502
US

V. Phone/Fax

Practice location:
  • Phone: 202-758-9347
  • Fax: 202-543-2758
Mailing address:
  • Phone: 202-758-9347
  • Fax: 202-543-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1049231
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: