Healthcare Provider Details

I. General information

NPI: 1205427366
Provider Name (Legal Business Name): CHEWAH NGWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9757 GOOD LUCK RD APT 7
LANHAM MD
20706-3327
US

IV. Provider business mailing address

9757 GOOD LUCK RD APT 7
LANHAM MD
20706-3327
US

V. Phone/Fax

Practice location:
  • Phone: 240-906-7804
  • Fax:
Mailing address:
  • Phone: 240-906-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA0000812913
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: