Provider Demographics
NPI:1972127231
Name:NGANTCHE, MADJOU STELLA (PMHNP)
Entity type:Individual
Prefix:
First Name:MADJOU
Middle Name:STELLA
Last Name:NGANTCHE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 WISCONSIN AVE APT 1116
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3159
Mailing Address - Country:US
Mailing Address - Phone:518-542-2851
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 305
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4142
Practice Address - Country:US
Practice Address - Phone:518-542-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212256363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health