Provider Demographics
NPI:1447689377
Name:NGAKO, JOELLE
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:NGAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 ASHFORD BLVD
Mailing Address - Street 2:109
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-328-6876
Mailing Address - Fax:
Practice Address - Street 1:8301 ASHFORD BLVD
Practice Address - Street 2:109
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5601
Practice Address - Country:US
Practice Address - Phone:301-328-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8453251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2242441309Medicare PIN