MEDICARE: MRS. EMILIENNE NGUATEM NKEMAYIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	R196070	MD
2	163WM0705X	Medical-Surgical Registered Nurse	R196070	MD
3	363LA2100X	Acute Care Nurse Practitioner	R196070	MD

General Provider Information

NPI Number	:	1093224149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILIENNE NGUATEM NKEMAYIM

Provider Business Mailing Address
First Line	:	1604 RIDGESIDE DR
Second Line	:	B2
City	:	MT AIRY
State	:	MD
Zip	:	21771
Country	:	US
Telephone Number	:	410-498-7055
Fax Number	:	410-862-4191

Provider Business Practice Location Address
First Line	:	1604 RIDGESIDE DR
Second Line	:	B2
City	:	MT AIRY
State	:	MD
Zip	:	21771
Country	:	US
Telephone Number	:	410-498-7055
Fax Number	:	410-862-4191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/17/2025

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Directions to “ MRS. EMILIENNE NGUATEM NKEMAYIM ” Practice Location

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