Provider Demographics
NPI:1356967855
Name:KAMGA, MARINET ADE (NP)
Entity type:Individual
Prefix:
First Name:MARINET
Middle Name:ADE
Last Name:KAMGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 OLD MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4204
Mailing Address - Country:US
Mailing Address - Phone:301-646-4891
Mailing Address - Fax:
Practice Address - Street 1:8898 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4204
Practice Address - Country:US
Practice Address - Phone:301-646-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169743163WM0705X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical