Provider Demographics
NPI:1326659723
Name:ATEM, MARY NKEGAFEH SR
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NKEGAFEH
Last Name:ATEM
Suffix:SR
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 1:2411 LYTTONSVILLE RD APT 301
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1926
Mailing Address - Country:US
Mailing Address - Phone:240-355-1875
Mailing Address - Fax:
Practice Address - Street 1:2411 LYTTONSVILLE RD APT 301
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1926
Practice Address - Country:US
Practice Address - Phone:240-355-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC15296251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health