MEDICARE: CAROLINE NKEMNKENG

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	164W00000X	Licensed Practical Nurse	LPN1004273	DC

General Provider Information

NPI Number	:	1902503972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE NKEMNKENG

Provider Business Mailing Address
First Line	:	13513 HOLLOW LOG DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-4220
Country	:	US
Telephone Number	:	240-505-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	13513 HOLLOW LOG DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-4220
Country	:	US
Telephone Number	:	240-505-3664
Fax Number	:

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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Directions to “ CAROLINE NKEMNKENG ” Practice Location

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