Provider Demographics
NPI:1578827762
Name:KEM, EUNICE MBAH (HHA)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:MBAH
Last Name:KEM
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FAIRVIEW AVE APT 601
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5952
Mailing Address - Country:US
Mailing Address - Phone:301-270-0750
Mailing Address - Fax:
Practice Address - Street 1:780 FAIRVIEW AVE APT 601
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5952
Practice Address - Country:US
Practice Address - Phone:301-270-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC2404667066374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide