Provider Demographics
NPI:1194597815
Name:NKEMNKENG, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:NKEMNKENG
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 1:7709 RIVERDALE RD APT 303
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3941
Mailing Address - Country:US
Mailing Address - Phone:407-350-7187
Mailing Address - Fax:
Practice Address - Street 1:7600 GEORGIA AVE NW STE 316
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1639
Practice Address - Country:US
Practice Address - Phone:240-705-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003134374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide