Provider Demographics
NPI:1497004535
Name:ADEMBUH, CHANTALE BIH
Entity Type:Individual
Prefix:
First Name:CHANTALE
Middle Name:BIH
Last Name:ADEMBUH
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 1:14121 BOWSPRIT LN
Mailing Address - Street 2:#301
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6301
Mailing Address - Country:US
Mailing Address - Phone:240-593-1547
Mailing Address - Fax:
Practice Address - Street 1:14121 BOWSPRIT LN
Practice Address - Street 2:#301
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6301
Practice Address - Country:US
Practice Address - Phone:240-593-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
TX933054163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No374U00000XNursing Service Related ProvidersHome Health Aide