Healthcare Provider Details

I. General information

NPI: 1093224149
Provider Name (Legal Business Name): MRS. EMILIENNE NGUATEM NKEMAYIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 RIDGESIDE DR B2
MT AIRY MD
21771
US

IV. Provider business mailing address

1604 RIDGESIDE DR B2
MT AIRY MD
21771
US

V. Phone/Fax

Practice location:
  • Phone: 410-498-7055
  • Fax: 410-862-4191
Mailing address:
  • Phone: 410-498-7055
  • Fax: 410-862-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR196070
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR196070
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR196070
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: