Provider Demographics
NPI:1174115885
Name:EMOMO NYONGI, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:EMOMO NYONGI
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 1:9235 LIVERY LN APT F
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1615
Mailing Address - Country:US
Mailing Address - Phone:301-328-6845
Mailing Address - Fax:
Practice Address - Street 1:9235 LIVERY LN APT F
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1615
Practice Address - Country:US
Practice Address - Phone:301-328-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20202893376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide