MEDICARE: SANDRINE M. ATEMEKENG CRNP-PMH

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R206844	MD

General Provider Information

NPI Number	:	1386327997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRINE M. ATEMEKENG CRNP-PMH

Provider Business Mailing Address
First Line	:	619 BUSHYTAIL DR
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-2232
Country	:	US
Telephone Number	:	240-386-9436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 BUCKEYSTOWN PIKE STE 308
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-8373
Country	:	US
Telephone Number	:	240-422-9216
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/10/2023

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