Healthcare Provider Details

I. General information

NPI: 1427912419
Provider Name (Legal Business Name): GENEVIEVE T. NDJOKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7678 QUARTERFIELD RD STE 201
GLEN BURNIE MD
21061-7071
US

IV. Provider business mailing address

7755 VENICE LN
SEVERN MD
21144-3265
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-9413
  • Fax:
Mailing address:
  • Phone: 301-523-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR247604
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: