=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477017085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHODA PALMIRA NDAMUKONG CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2019
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3261 OLD WASHINGTON RD STE 3010
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-527-7246
-----------------------------------------------------
Fax | 866-229-5063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4449 CRAIN HWY
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20695-3046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-302-4671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | R199268
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------