Provider Demographics
NPI:1053667824
Name:NGEDZEYEEM, ISABELLA KENYEN
Entity Type:Individual
Prefix:MS
First Name:ISABELLA
Middle Name:KENYEN
Last Name:NGEDZEYEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 BENNING RD NE # 0
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4800
Mailing Address - Country:US
Mailing Address - Phone:202-595-9003
Mailing Address - Fax:202-595-9009
Practice Address - Street 1:2407 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4800
Practice Address - Country:US
Practice Address - Phone:202-595-9003
Practice Address - Fax:202-595-9009
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1044114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner