Provider Demographics
NPI:1245585611
Name:NGAM, BERENICE MUMBEMSA (CRNP-PMH)
Entity type:Individual
Prefix:DR
First Name:BERENICE
Middle Name:MUMBEMSA
Last Name:NGAM
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:BERENICE
Other - Middle Name:
Other - Last Name:ANJEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8101 SANDY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3596
Mailing Address - Country:US
Mailing Address - Phone:240-532-4752
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:240-532-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213701363LP0808X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No374U00000XNursing Service Related ProvidersHome Health Aide