Provider Demographics
NPI:1770352452
Name:NDIKUM, GRACE LUMKONG
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LUMKONG
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 1:9737 GOOD LUCK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3318
Mailing Address - Country:US
Mailing Address - Phone:301-549-2279
Mailing Address - Fax:
Practice Address - Street 1:9737 GOOD LUCK RD APT 3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3318
Practice Address - Country:US
Practice Address - Phone:301-549-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide