Provider Demographics
NPI:1952949299
Name:KEMVO, ODETTE SOLANGE (NP)
Entity Type:Individual
Prefix:MS
First Name:ODETTE
Middle Name:SOLANGE
Last Name:KEMVO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 FOXCHASE LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5909
Mailing Address - Country:US
Mailing Address - Phone:443-600-1620
Mailing Address - Fax:
Practice Address - Street 1:1057 FOXCHASE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5909
Practice Address - Country:US
Practice Address - Phone:443-600-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207929363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health