Provider Demographics
NPI:1356895064
Name:NKEMATABONG, ATABONG (HHA)
Entity type:Individual
Prefix:
First Name:ATABONG
Middle Name:
Last Name:NKEMATABONG
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 BREEZEWOOD DR
Mailing Address - Street 2:APT 303
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1128
Mailing Address - Country:US
Mailing Address - Phone:301-454-9933
Mailing Address - Fax:
Practice Address - Street 1:6220 BREEZEWOOD DR
Practice Address - Street 2:APT 303
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1128
Practice Address - Country:US
Practice Address - Phone:301-454-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12306374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide