Healthcare Provider Details

I. General information

NPI: 1982294930
Provider Name (Legal Business Name): CLAUDETTE B MENKENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 RIVERDALE RD APT 203
NEW CARROLLTON MD
20784-4025
US

IV. Provider business mailing address

7843 RIVERDALE RD APT 203
NEW CARROLLTON MD
20784-4025
US

V. Phone/Fax

Practice location:
  • Phone: 240-260-8742
  • Fax:
Mailing address:
  • Phone: 240-260-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberHHA15624
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: