Provider Demographics
NPI:1962832956
Name:NGUEMBU, MANUELLA CLAUDE
Entity Type:Individual
Prefix:
First Name:MANUELLA CLAUDE
Middle Name:
Last Name:NGUEMBU
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 1:10745 CASTLETON TURN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1449
Mailing Address - Country:US
Mailing Address - Phone:202-779-4726
Mailing Address - Fax:
Practice Address - Street 1:2708 KIRKWOOD PL
Practice Address - Street 2:APT 103
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2637
Practice Address - Country:US
Practice Address - Phone:202-412-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide