Provider Demographics
NPI:1629609243
Name:NKOLEKWA, BRENDA SIMON
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SIMON
Last Name:NKOLEKWA
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 1:3358 CHILLUM RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1142
Mailing Address - Country:US
Mailing Address - Phone:240-429-0620
Mailing Address - Fax:
Practice Address - Street 1:2503 14TH ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1953
Practice Address - Country:US
Practice Address - Phone:202-832-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant