Healthcare Provider Details

I. General information

NPI: 1326550963
Provider Name (Legal Business Name): CHARLOTTE EBONG NDEMA APRN-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HOSPITAL DR
CHEVERLY MD
20785-1194
US

IV. Provider business mailing address

4211 FALCONWOOD PL
BURTONSVILLE MD
20866-1300
US

V. Phone/Fax

Practice location:
  • Phone: 301-583-3700
  • Fax: 301-583-3735
Mailing address:
  • Phone: 301-325-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR227510
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: