Provider Demographics
NPI:1851658033
Name:ATANGA, ATEMNKENG CLUDIA
Entity Type:Individual
Prefix:
First Name:ATEMNKENG
Middle Name:CLUDIA
Last Name:ATANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATEMNKENG
Other - Middle Name:
Other - Last Name:CLUDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5504 TRACEY BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21710-8914
Mailing Address - Country:US
Mailing Address - Phone:240-706-2216
Mailing Address - Fax:
Practice Address - Street 1:5504 TRACEY BRUCE DR
Practice Address - Street 2:
Practice Address - City:ADAMSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21710-8914
Practice Address - Country:US
Practice Address - Phone:240-706-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDR226438363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No374U00000XNursing Service Related ProvidersHome Health Aide