Provider Demographics
NPI:1437746203
Name:KEMAJOU, ALINE JACKIE
Entity Type:Individual
Prefix:
First Name:ALINE JACKIE
Middle Name:
Last Name:KEMAJOU
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 1:4903 KIRBYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1462
Mailing Address - Country:US
Mailing Address - Phone:301-283-1854
Mailing Address - Fax:
Practice Address - Street 1:5890 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2617
Practice Address - Country:US
Practice Address - Phone:667-214-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG12200082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner