Healthcare Provider Details

I. General information

NPI: 1962911008
Provider Name (Legal Business Name): VANESSA TONGIONG KENFACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 RIVERDALE RD APT T3
NEW CARROLLTON MD
20784-4023
US

IV. Provider business mailing address

7841 RIVERDALE RD APT T3
NEW CARROLLTON MD
20784-4023
US

V. Phone/Fax

Practice location:
  • Phone: 240-505-8930
  • Fax:
Mailing address:
  • Phone: 240-505-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13123
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: