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NPI Code Detail

MEDICARE: MISS CRESCENTIA CHONGONG AKUMBOM

MEDICARE: MISS CRESCENTIA CHONGONG AKUMBOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse34750DC

General Provider Information

NPI Number : 1073867826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CRESCENTIA CHONGONG AKUMBOM
Provider Business Mailing Address
First Line : 6475 NEW HAMPSHIRE AVE STE 504F
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20783-3277
Country : US
Telephone Number : 301-560-1352
Fax Number : 301-238-4714
Provider Business Practice Location Address
First Line : 6475 NEW HAMPSHIRE AVE STE 504F
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20783-3277
Country : US
Telephone Number : 301-560-1352
Fax Number : 301-238-4714
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2012
Last Update Date : 11/01/2012

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Practice Fax:

Directions to “ MISS CRESCENTIA CHONGONG AKUMBOM ” Practice Location

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