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General NPI Number Information
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NPI Number | 1558026542
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Entity Type | Individual
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Provider Name | CHANTAL NYEFEN FOKUM CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1512 LARKSPUR CT
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-2314
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Country | US
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Telephone | 240-593-3792
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Fax |
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Provider Business Mailing Address
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Address Line | 2 UNIVERSITY PLZ STE 204
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City | HACKENSACK
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State | NJ
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Zip | 07601-6211
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Country | US
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Telephone | 551-295-8223
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R162268
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R162268
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License Number State | MD
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