Individual
ANSELM AZONGHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
6003 67TH AVE, APT 3, RIVERDALE, MD 20737-1756
(301) 377-8182
Mailing address
6003 67TH AVE, APT 3, RIVERDALE, MD 20737-1756
(301) 377-8182
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN1005237
DC
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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