Provider Demographics
NPI:1700336872
Name:NDIKUM, CAROLINE
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:NDIKUM
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 1:3100 NEEDLELEAF LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2518
Mailing Address - Country:US
Mailing Address - Phone:713-584-3699
Mailing Address - Fax:
Practice Address - Street 1:3100 NEEDLELEAF LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-2518
Practice Address - Country:US
Practice Address - Phone:713-584-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12464374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide