Healthcare Provider Details

I. General information

NPI: 1366399354
Provider Name (Legal Business Name): MARIE SANDRA ENJOH NKAZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 CHILLUM RD APT 302
MOUNT RAINIER MD
20712-1145
US

IV. Provider business mailing address

3366 CHILLUM RD APT 302
MOUNT RAINIER MD
20712-1145
US

V. Phone/Fax

Practice location:
  • Phone: 443-810-9802
  • Fax:
Mailing address:
  • Phone: 443-810-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006270
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: