Anselm Azongho, LPN

Individual provider Active NPI Licensed Practical Nurse · Riverdale, MD

NPI 1932465002 · NPPES record last updated Apr 3, 2012

Key facts

NPI
1932465002
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LPN1005237 (DC)
Practice address
6003 67TH Ave
Apt 3
Riverdale, MD 20737-1756
Phone
(301) 377-8182
NPI assigned
Apr 3, 2012
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LPN1005237DCMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN1005237 DC Yes

Addresses

Primary practice location

6003 67TH Ave
Apt 3
Riverdale, MD 20737-1756

Mailing address

6003 67TH Ave
Apt 3
Riverdale, MD 20737-1756
Phone (301) 377-8182

Other providers in Riverdale, MD

All providers in Riverdale, MD · Licensed Practical Nurse in Maryland

Sources for this page

Verify at the official NPI Registry.