Provider Demographics
NPI:1437916350
Name:ATAKUNG EPSE MBENG, CHRISTINA ENGONG
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ENGONG
Last Name:ATAKUNG EPSE MBENG
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 1:4011 LAKEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3327
Mailing Address - Country:US
Mailing Address - Phone:910-977-6117
Mailing Address - Fax:
Practice Address - Street 1:4011 LAKEHOUSE RD
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3327
Practice Address - Country:US
Practice Address - Phone:910-977-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide