Provider Demographics
NPI:1841559663
Name:NKUNBUMA, TERENCE NDONG (HA)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:NDONG
Last Name:NKUNBUMA
Suffix:
Gender:M
Credentials:HA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 85TH AVE
Mailing Address - Street 2:#D1
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3247
Mailing Address - Country:US
Mailing Address - Phone:240-481-8511
Mailing Address - Fax:
Practice Address - Street 1:5308 85TH AVE
Practice Address - Street 2:#D1
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3247
Practice Address - Country:US
Practice Address - Phone:240-481-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program