Provider Demographics
NPI:1134755515
Name:NANA, CONCILIA NKEMBUH
Entity type:Individual
Prefix:
First Name:CONCILIA
Middle Name:NKEMBUH
Last Name:NANA
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 1:5601 13TH ST NW APT 323
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3564
Mailing Address - Country:US
Mailing Address - Phone:202-598-1520
Mailing Address - Fax:
Practice Address - Street 1:5601 13TH ST NW APT 323
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3564
Practice Address - Country:US
Practice Address - Phone:202-598-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide