Provider Demographics
NPI:1871259192
Name:BESONG, ALLEN (RN)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:BESONG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 RED CLAY RD APT 201
Mailing Address - Street 2:
Mailing Address - City:MARYLAND CITY
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2320
Mailing Address - Country:US
Mailing Address - Phone:240-481-8365
Mailing Address - Fax:
Practice Address - Street 1:261 RED CLAY RD APT 201
Practice Address - Street 2:
Practice Address - City:MARYLAND CITY
Practice Address - State:MD
Practice Address - Zip Code:20724-2320
Practice Address - Country:US
Practice Address - Phone:240-481-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN1047457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse