Provider Demographics
NPI:1306107156
Name:NKEMTAJI, MANYI ELISE
Entity type:Individual
Prefix:
First Name:MANYI
Middle Name:ELISE
Last Name:NKEMTAJI
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 1:1813 MOUNT PISGAH LN
Mailing Address - Street 2:APT 14
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2156
Mailing Address - Country:US
Mailing Address - Phone:240-938-9462
Mailing Address - Fax:
Practice Address - Street 1:1813 MOUNT PISGAH LN
Practice Address - Street 2:APT 14
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2156
Practice Address - Country:US
Practice Address - Phone:240-938-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN253581221827374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide