Healthcare Provider Details

I. General information

NPI: 1245718402
Provider Name (Legal Business Name): NADEGE YEMTCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KENILWORTH AVE APT 401E
BLADENSBURG MD
20710-2146
US

IV. Provider business mailing address

3801 KENILWORTH AVE APT 401E
BLADENSBURG MD
20710-2146
US

V. Phone/Fax

Practice location:
  • Phone: 301-809-7239
  • Fax:
Mailing address:
  • Phone: 301-809-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberHHA13868
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: