Provider Demographics
NPI:1780224592
Name:NEMBO PAULINE, MALU
Entity Type:Individual
Prefix:
First Name:MALU
Middle Name:
Last Name:NEMBO PAULINE
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 1:9969 GOOD LUCK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3277
Mailing Address - Country:US
Mailing Address - Phone:240-495-4521
Mailing Address - Fax:
Practice Address - Street 1:9969 GOOD LUCK RD APT 101
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3277
Practice Address - Country:US
Practice Address - Phone:240-495-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide