Healthcare Provider Details

I. General information

NPI: 1083100903
Provider Name (Legal Business Name): SOLANGE LUM NGWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KENILWORTH AVE APT 401E
BLADENSBURG MD
20710
US

IV. Provider business mailing address

3801 KENILWORTH AVE APT 401E
BLADENSBURG MD
20710-2146
US

V. Phone/Fax

Practice location:
  • Phone: 202-527-8002
  • Fax: 301-339-4396
Mailing address:
  • Phone: 202-527-8002
  • Fax: 301-339-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: