Provider Demographics
NPI:1376367821
Name:NKOMBU, VANESSA FOTABONG
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:FOTABONG
Last Name:NKOMBU
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 1:1823 BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2779
Mailing Address - Country:US
Mailing Address - Phone:202-200-1311
Mailing Address - Fax:
Practice Address - Street 1:1823 BARRINGTON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2779
Practice Address - Country:US
Practice Address - Phone:202-200-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide