Provider Demographics
NPI:1093288532
Name:ATEGHANG, NYEDIANG SALOME (FNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:NYEDIANG
Middle Name:SALOME
Last Name:ATEGHANG
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:NYEDIANG
Other - Middle Name:SALOME
Other - Last Name:ATEGHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1006 KINGS HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2010
Mailing Address - Country:US
Mailing Address - Phone:240-838-2560
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199045363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty