Provider Demographics
NPI:1710750419
Name:NKENGAFAC, NESTOR
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:NKENGAFAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 DODGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2112
Mailing Address - Country:US
Mailing Address - Phone:443-431-9154
Mailing Address - Fax:
Practice Address - Street 1:3309 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2112
Practice Address - Country:US
Practice Address - Phone:443-431-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide