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Individual

FIDELIS NGWA AMBE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3500 18TH ST NE, WASHINGTON, DC 20018-2738
(202) 529-6510
Mailing address
306 EVARTS ST NE APT 105, WASHINGTON, DC 20002-1040

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
HHA12973
DC
374U00000X
Home Health Aide
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
70904352
TRUSTED HEALTH PLAN
Enumeration date
09/07/2017
Last updated
09/08/2017
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