Provider Demographics
NPI:1598412322
Name:SIMO WAKAM, ARISTIDE NADEGE
Entity Type:Individual
Prefix:
First Name:ARISTIDE
Middle Name:NADEGE
Last Name:SIMO WAKAM
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 1:9136 EDMONSTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1527
Mailing Address - Country:US
Mailing Address - Phone:240-719-1782
Mailing Address - Fax:
Practice Address - Street 1:9136 EDMONSTON CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1527
Practice Address - Country:US
Practice Address - Phone:240-719-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide