Provider Demographics
NPI:1790363828
Name:FOKALA-NDAKWAH, JUSTINE ATUGYE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ATUGYE
Last Name:FOKALA-NDAKWAH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WATKINS PARK DR UNIT 4640
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20775-7526
Mailing Address - Country:US
Mailing Address - Phone:240-688-2263
Mailing Address - Fax:
Practice Address - Street 1:68 WATKINS
Practice Address - Street 2:SUITE 4640
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20775-7043
Practice Address - Country:US
Practice Address - Phone:240-688-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNONEOtherNONE