Provider Demographics
NPI:1093224149
Name:NKEMAYIM, EMILIENNE NGUATEM
Entity type:Individual
Prefix:MRS
First Name:EMILIENNE
Middle Name:NGUATEM
Last Name:NKEMAYIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 RIDGESIDE DR
Mailing Address - Street 2:B2
Mailing Address - City:MT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771
Mailing Address - Country:US
Mailing Address - Phone:410-498-7055
Mailing Address - Fax:410-862-4191
Practice Address - Street 1:5401 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5103
Practice Address - Country:US
Practice Address - Phone:410-521-2200
Practice Address - Fax:410-862-4191
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196070363LP2300X, 163WM0705X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care