MEDICARE: RHODA PALMIRA NDAMUKONG CRNP

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	R199268	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R199268	OTHER	MD	NURSE PRACTITIONER

General Provider Information

NPI Number	:	1477017085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHODA PALMIRA NDAMUKONG CRNP

Provider Business Mailing Address
First Line	:	4449 CRAIN HWY
Second Line	:
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3046
Country	:	US
Telephone Number	:	202-302-4671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3261 OLD WASHINGTON RD STE 3010
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3229
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

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

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	02/06/2026

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