=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518326362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMERENCIA NKAFU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 03/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7713 RIVERDALE RD APT 102
-----------------------------------------------------
City | NEW CARROLLTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20784-3945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-305-7362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7869 RIVERDALE RD APT 303
-----------------------------------------------------
City | NEW CARROLLTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20784-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-305-7362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | HHA11836
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------