Provider Demographics
NPI:1457135220
Name:ATEM, MAURICE ACHANKENG (RN)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:ACHANKENG
Last Name:ATEM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15003 JANDLEWAY CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7299
Mailing Address - Country:US
Mailing Address - Phone:240-755-5220
Mailing Address - Fax:
Practice Address - Street 1:15003 JANDLEWAY CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7299
Practice Address - Country:US
Practice Address - Phone:240-755-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1051835163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management