Provider Demographics
NPI:1790172682
Name:ATEHNCHONG, ADELE
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:ATEHNCHONG
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 1:8012 CRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3050
Mailing Address - Country:US
Mailing Address - Phone:240-755-5868
Mailing Address - Fax:
Practice Address - Street 1:8012 CRADDOCK RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3050
Practice Address - Country:US
Practice Address - Phone:240-755-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11205374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide