Provider Demographics
NPI:1073871778
Name:MENKEMTEBA, NEMBO ANDREAS I (HHA)
Entity Type:Individual
Prefix:MR
First Name:NEMBO
Middle Name:ANDREAS
Last Name:MENKEMTEBA
Suffix:I
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:4428 68TH PL
Mailing Address - Street 2:APT C3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2016
Mailing Address - Country:US
Mailing Address - Phone:240-838-6015
Mailing Address - Fax:202-529-6570
Practice Address - Street 1:4428 68TH PLACE
Practice Address - Street 2:APT C3
Practice Address - City:HYATSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2016
Practice Address - Country:US
Practice Address - Phone:240-838-6015
Practice Address - Fax:202-529-6570
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM-525-626-027-030374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide