Provider Demographics
NPI:1043579022
Name:EGEMENE, ATEM CYPRAIN
Entity Type:Individual
Prefix:
First Name:ATEM
Middle Name:CYPRAIN
Last Name:EGEMENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1501
Mailing Address - Country:US
Mailing Address - Phone:301-675-8553
Mailing Address - Fax:
Practice Address - Street 1:9226 WILLOW LN
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1501
Practice Address - Country:US
Practice Address - Phone:301-675-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE255073107835374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide