Provider Demographics
NPI:1124853171
Name:NTENNOU, DONATIEN NDOUNGWA (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:DONATIEN
Middle Name:NDOUNGWA
Last Name:NTENNOU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 INDEPENDENCE PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5222
Mailing Address - Country:US
Mailing Address - Phone:757-965-5886
Mailing Address - Fax:
Practice Address - Street 1:638 INDEPENDENCE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5222
Practice Address - Country:US
Practice Address - Phone:757-965-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191144363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health