Provider Demographics
NPI:1912416538
Name:NAMME, VANESSA EWONGO
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:EWONGO
Last Name:NAMME
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 1:7741 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7741 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3911
Practice Address - Country:US
Practice Address - Phone:240-746-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2023-07-18
Deactivation Date:2023-03-26
Deactivation Code:
Reactivation Date:2023-03-30
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 171M00000X
DCHHA13110374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide