Healthcare Provider Details

I. General information

NPI: 1346505252
Provider Name (Legal Business Name): LINDA EMETAH NKONGCHU NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

4300 CEDAR REACH LN
BOWIE MD
20720-5808
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-8100
  • Fax: 301-390-8086
Mailing address:
  • Phone: 240-713-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR192716
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: