Provider Demographics
NPI:1962040113
Name:NKEMDIRIM, VIOLET NONYE
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:NONYE
Last Name:NKEMDIRIM
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 1:4003 LARGA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4062
Mailing Address - Country:US
Mailing Address - Phone:862-930-8809
Mailing Address - Fax:
Practice Address - Street 1:4003 LARGA VISTA CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-4062
Practice Address - Country:US
Practice Address - Phone:862-930-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14684374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide