Provider Demographics
NPI:1750710851
Name:EMAMBOT EPSE NKAFU, CHARLOTTEELAD
Entity type:Individual
Prefix:
First Name:CHARLOTTEELAD
Middle Name:
Last Name:EMAMBOT EPSE NKAFU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 85TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4518
Mailing Address - Country:US
Mailing Address - Phone:703-340-6062
Mailing Address - Fax:
Practice Address - Street 1:5433 85TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4518
Practice Address - Country:US
Practice Address - Phone:703-340-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9782374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide