Healthcare Provider Details

I. General information

NPI: 1770843385
Provider Name (Legal Business Name): ABONG NASANG MIYEH MHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14729 4TH ST UNIT 228
LAUREL MD
20707-4024
US

IV. Provider business mailing address

14729 4TH ST UNIT 228
LAUREL MD
20707-4024
US

V. Phone/Fax

Practice location:
  • Phone: 120-235-2405
  • Fax:
Mailing address:
  • Phone: 120-235-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1049995
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR234090
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1049995
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: