Healthcare Provider Details

I. General information

NPI: 1073916037
Provider Name (Legal Business Name): JESSINTA NGUNKENG CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 ANNAPOLIS RD STE D
LANHAM MD
20706-3030
US

IV. Provider business mailing address

9430 ANNAPOLIS RD
LANHAM MD
20706-3004
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-4732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR197237
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1025199
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: