Provider Demographics
NPI:1053168591
Name:NGONG, ELIANE ISI
Entity type:Individual
Prefix:
First Name:ELIANE
Middle Name:ISI
Last Name:NGONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 57TH AVE APT B7
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1668
Mailing Address - Country:US
Mailing Address - Phone:410-900-2722
Mailing Address - Fax:
Practice Address - Street 1:5018 57TH AVE APT B7
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1668
Practice Address - Country:US
Practice Address - Phone:410-900-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty