Provider Demographics
NPI:1942014527
Name:EPSE KAMGANG, ELISABETH O
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:O
Last Name:EPSE KAMGANG
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 1:3217 SWANN RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1323
Mailing Address - Country:US
Mailing Address - Phone:240-438-1671
Mailing Address - Fax:
Practice Address - Street 1:3217 SWANN RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1323
Practice Address - Country:US
Practice Address - Phone:240-438-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HHA200004487374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide