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General NPI Number Information
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NPI Number | 1447514187
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Entity Type | Individual
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Provider Name | DANIEL NDAMUKONG
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Gender | Male
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 12008 CASTLE PINES LN
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City | WALDORF
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State | MD
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Zip | 20602-3183
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Country | US
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Telephone | 202-258-5671
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Fax | 240-607-6760
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Provider Business Mailing Address
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Address Line | 1731 BUNKER HILL RD NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3026
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Country | US
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Telephone | 202-635-6133
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Fax | 202-635-5780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | RN963469
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R149775
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License Number State | MD
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