Healthcare Provider Details

I. General information

NPI: 1154266286
Provider Name (Legal Business Name): MS. EMMELINE AMBE TUMANJONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MISSOURI CT
FREDERICK MD
21702-6450
US

IV. Provider business mailing address

122 MISSOURI CT
FREDERICK MD
21702-6450
US

V. Phone/Fax

Practice location:
  • Phone: 240-344-5817
  • Fax:
Mailing address:
  • Phone: 240-344-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR177206
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: