MEDICARE: MARLYSE WANKO KUETE

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	R228980	MD

General Provider Information

NPI Number	:	1871449611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLYSE WANKO KUETE

Provider Business Mailing Address
First Line	:	5513 GOLDEN EAGLE RD
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-6751
Country	:	US
Telephone Number	:	240-507-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5513 GOLDEN EAGLE RD
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-6751
Country	:	US
Telephone Number	:	240-507-8277
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MARLYSE WANKO KUETE ” Practice Location

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