Provider Demographics
NPI:1689308686
Name:NGEMUKUM, MARCKLYN
Entity Type:Individual
Prefix:
First Name:MARCKLYN
Middle Name:
Last Name:NGEMUKUM
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 1:9514 NORDIC DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3630
Mailing Address - Country:US
Mailing Address - Phone:240-726-0986
Mailing Address - Fax:
Practice Address - Street 1:9514 NORDIC DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3630
Practice Address - Country:US
Practice Address - Phone:240-726-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20213947376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide