Provider Demographics
NPI:1619590817
Name:ENE, CAROLINE NKECHINYERE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NKECHINYERE
Last Name:ENE
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 1:9515 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5444
Mailing Address - Country:US
Mailing Address - Phone:240-486-2779
Mailing Address - Fax:
Practice Address - Street 1:12210 MALTA LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1812
Practice Address - Country:US
Practice Address - Phone:240-486-2779
Practice Address - Fax:240-500-1749
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160096163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse