Provider Demographics
NPI:1316766306
Name:ATABONG NKENG, RENETA
Entity type:Individual
Prefix:
First Name:RENETA
Middle Name:
Last Name:ATABONG NKENG
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 1:1936 KENNEDY DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1936
Mailing Address - Country:US
Mailing Address - Phone:202-707-4874
Mailing Address - Fax:
Practice Address - Street 1:1936 KENNEDY DR APT 202
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1936
Practice Address - Country:US
Practice Address - Phone:202-707-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001328170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse