Provider Demographics
NPI:1487096970
Name:MAMBE, NAKOMO ATUM
Entity type:Individual
Prefix:MR
First Name:NAKOMO
Middle Name:ATUM
Last Name:MAMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 BERLEIGH HILL CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1391
Mailing Address - Country:US
Mailing Address - Phone:301-339-4892
Mailing Address - Fax:443-660-9717
Practice Address - Street 1:3711 BERLEIGH HILL CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1391
Practice Address - Country:US
Practice Address - Phone:301-339-4892
Practice Address - Fax:443-660-9717
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program