Healthcare Provider Details

I. General information

NPI: 1871298919
Provider Name (Legal Business Name): DANNY YOLANDE KENFACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 MUESERBUSH CT
GLENARDEN MD
20706-5524
US

IV. Provider business mailing address

2905 MUESERBUSH CT
GLENARDEN MD
20706-5524
US

V. Phone/Fax

Practice location:
  • Phone: 443-675-8602
  • Fax:
Mailing address:
  • Phone: 443-675-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN200002618
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: