Provider Demographics
NPI:1114398005
Name:NKONKENG, ADELINE
Entity Type:Individual
Prefix:MISS
First Name:ADELINE
Middle Name:
Last Name:NKONKENG
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 1:6809 LANDON CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3048
Mailing Address - Country:US
Mailing Address - Phone:240-486-7136
Mailing Address - Fax:
Practice Address - Street 1:6809 LANDON CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3048
Practice Address - Country:US
Practice Address - Phone:240-486-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11547374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide