Healthcare Provider Details

I. General information

NPI: 1609765510
Provider Name (Legal Business Name): WINIFRED NCHOCKNGAM MEPHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 15TH ST NE
WASHINGTON DC
20002-4508
US

IV. Provider business mailing address

2410 ARTESIAN LN
BOWIE MD
20716-3802
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-1270
  • Fax:
Mailing address:
  • Phone: 240-705-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN200006569
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: