Provider Demographics
NPI:1710784756
Name:BONA NGUEBI VEUVE MASSOUA, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BONA NGUEBI VEUVE MASSOUA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 BUCK LODGE RD
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1539
Mailing Address - Country:US
Mailing Address - Phone:240-467-1839
Mailing Address - Fax:
Practice Address - Street 1:2523 BUCK LODGE RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1539
Practice Address - Country:US
Practice Address - Phone:240-467-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004420374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide