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General NPI Number Information
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NPI Number | 1417732306
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Entity Type | Individual
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Provider Name | HANDERSON A ATONGNONG
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Gender | Male
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 8928 CONTINENTAL PL
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City | LANDOVER
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State | MD
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Zip | 20785-4730
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Country | US
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Telephone | 240-898-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 8928 CONTINENTAL PL
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City | LANDOVER
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State | MD
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Zip | 20785-4730
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA200001340
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License Number State | DC
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