Healthcare Provider Details

I. General information

NPI: 1356967855
Provider Name (Legal Business Name): MARINET ADE KAMGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8898 OLD MONTGOMERY RD
COLUMBIA MD
21045-4204
US

IV. Provider business mailing address

8898 OLD MONTGOMERY RD
COLUMBIA MD
21045-4204
US

V. Phone/Fax

Practice location:
  • Phone: 301-646-4891
  • Fax:
Mailing address:
  • Phone: 301-646-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR169743
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR169743
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: