Healthcare Provider Details

I. General information

NPI: 1508322942
Provider Name (Legal Business Name): WILLIAM NKEMACHA JINGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 HARDWOOD DR
LANHAM MD
20706-2858
US

IV. Provider business mailing address

6301 HARDWOOD DR
LANHAM MD
20706-2858
US

V. Phone/Fax

Practice location:
  • Phone: 240-505-8260
  • Fax:
Mailing address:
  • Phone: 240-505-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13104
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: