Provider Demographics
NPI:1932574738
Name:ATEMNKENG, SIDONIE BEANJU
Entity Type:Individual
Prefix:
First Name:SIDONIE
Middle Name:BEANJU
Last Name:ATEMNKENG
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 1:13600 BARNET LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3461
Mailing Address - Country:US
Mailing Address - Phone:520-336-3026
Mailing Address - Fax:
Practice Address - Street 1:13600 BARNET LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3461
Practice Address - Country:US
Practice Address - Phone:520-336-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11593374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide