Provider Demographics
NPI:1477815975
Name:NANA, CHRISTELLE NBUTOBOG
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:NBUTOBOG
Last Name:NANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTELLE
Other - Middle Name:
Other - Last Name:NBUTOBOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHRISTELLE NBUTOBOG
Mailing Address - Street 1:13918 CASTLE BLVD
Mailing Address - Street 2:APT 304
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4954
Mailing Address - Country:US
Mailing Address - Phone:678-740-4602
Mailing Address - Fax:
Practice Address - Street 1:13918 CASTLE BLVD
Practice Address - Street 2:APT 304
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4954
Practice Address - Country:US
Practice Address - Phone:678-740-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN-131-115-018-334374U00000X
MDN-500-115-623-334171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide