Provider Demographics
NPI:1972352912
Name:KEM EPSE NDIFOR, KAREN EYANG
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:EYANG
Last Name:KEM EPSE NDIFOR
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 1:423 KETTERING DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1522
Mailing Address - Country:US
Mailing Address - Phone:240-486-7106
Mailing Address - Fax:
Practice Address - Street 1:1810 SAHARA LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2736
Practice Address - Country:US
Practice Address - Phone:240-940-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003740374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide