Provider Demographics
NPI:1770365140
Name:NKENG, NACISSE E N
Entity type:Individual
Prefix:
First Name:NACISSE E N
Middle Name:
Last Name:NKENG
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 1:1806 METZEROTT RD APT 504
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5122
Mailing Address - Country:US
Mailing Address - Phone:240-608-8395
Mailing Address - Fax:
Practice Address - Street 1:1806 METZEROTT RD APT 504
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5122
Practice Address - Country:US
Practice Address - Phone:240-608-8395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician