Healthcare Provider Details

I. General information

NPI: 1215752118
Provider Name (Legal Business Name): FATIMA NCHANGHA NGAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GREACIAN AVE
DAYTON OH
45426-3042
US

IV. Provider business mailing address

14 GREACIAN AVE
DAYTON OH
45426-3042
US

V. Phone/Fax

Practice location:
  • Phone: 240-751-2449
  • Fax:
Mailing address:
  • Phone: 240-751-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: