Provider Demographics
NPI:1477017085
Name:NDAMUKONG, RHODA PALMIRA (CRNP)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:PALMIRA
Last Name:NDAMUKONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3046
Mailing Address - Country:US
Mailing Address - Phone:202-302-4671
Mailing Address - Fax:
Practice Address - Street 1:4449 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3046
Practice Address - Country:US
Practice Address - Phone:202-302-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR199268OtherNURSE PRACTITIONER