Provider Demographics
NPI:1467850396
Name:KAMTCHUENG, THERESE I
Entity Type:Individual
Prefix:MISS
First Name:THERESE
Middle Name:
Last Name:KAMTCHUENG
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KAMTCHUENG
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2401 BLUERIDGE AVE
Mailing Address - Street 2:2401 BLUERIDGE AVE
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4517
Mailing Address - Country:US
Mailing Address - Phone:301-949-0466
Mailing Address - Fax:301-933-2007
Practice Address - Street 1:2401 BLUERIDGE AVE
Practice Address - Street 2:301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2090
Practice Address - Country:US
Practice Address - Phone:301-949-0466
Practice Address - Fax:301-933-2007
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide