Healthcare Provider Details

I. General information

NPI: 1730956699
Provider Name (Legal Business Name): LUCAS ESAMBE NKEDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 02/02/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 VICARAGE CT
BOWIE MD
20721-3182
US

IV. Provider business mailing address

2601 VICARAGE CT
BOWIE MD
20721-3182
US

V. Phone/Fax

Practice location:
  • Phone: 240-755-6509
  • Fax:
Mailing address:
  • Phone: 240-755-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: