MEDICARE: VALMY NKIENYACK FOTENDONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R224266	MD

General Provider Information

NPI Number	:	1730543281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALMY NKIENYACK FOTENDONG

Provider Business Mailing Address
First Line	:	7375 EXECUTIVE PL
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2278
Country	:	US
Telephone Number	:	301-937-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 WINTER PARK CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7550
Country	:	US
Telephone Number	:	301-675-2451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	01/27/2023

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