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General NPI Number Information
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NPI Number | 1477815975
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Entity Type | Individual
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Provider Name | CHRISTELLE NBUTOBOG NANA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 13918 CASTLE BLVD APT 304
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City | SILVER SPRING
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State | MD
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Zip | 20904-4954
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Country | US
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Telephone | 678-740-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 13918 CASTLE BLVD APT 304
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City | SILVER SPRING
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State | MD
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Zip | 20904-4954
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Country | US
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Telephone | 678-740-4602
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Fax |
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | N-131-115-018-334
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | N-500-115-623-334
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License Number State | MD
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