Healthcare Provider Details

I. General information

NPI: 1730543281
Provider Name (Legal Business Name): VALMY NKIENYACK FOTENDONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 FORT BAKER DR SE
WASHINGTON DC
20020-7274
US

IV. Provider business mailing address

7375 EXECUTIVE PL
LANHAM MD
20706-2278
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-4863
  • Fax: 443-513-2664
Mailing address:
  • Phone: 301-937-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPI1730543281
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: