Healthcare Provider Details

I. General information

NPI: 1669984308
Provider Name (Legal Business Name): ROMANUS L NZENGUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 POTOMAC HIGHLANDS CIR
TRIANGLE VA
22172-1782
US

IV. Provider business mailing address

4403 POTOMAC HIGHLANDS CIR
TRIANGLE VA
22172-1782
US

V. Phone/Fax

Practice location:
  • Phone: 404-542-1427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1046343
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: