Provider Demographics
NPI:1639430077
Name:MENKEM, KENDUANYI
Entity type:Individual
Prefix:
First Name:KENDUANYI
Middle Name:
Last Name:MENKEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ELK NEST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-5109
Mailing Address - Country:US
Mailing Address - Phone:240-550-4104
Mailing Address - Fax:
Practice Address - Street 1:320 ELK NEST DR
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-5109
Practice Address - Country:US
Practice Address - Phone:240-550-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide