Provider Demographics
NPI:1760741383
Name:NKEMATABONG, PAMELA BEBONGCHU
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:BEBONGCHU
Last Name:NKEMATABONG
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 1:6220 BREEZEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1128
Mailing Address - Country:US
Mailing Address - Phone:240-646-6216
Mailing Address - Fax:
Practice Address - Street 1:6220 BREEZEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1128
Practice Address - Country:US
Practice Address - Phone:240-646-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2536763641374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide