Provider Demographics
NPI:1518791607
Name:SHERMUTANG, CHOP EDWIN (RN)
Entity type:Individual
Prefix:
First Name:CHOP
Middle Name:EDWIN
Last Name:SHERMUTANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5646 WHITFIELD CHAPEL RD APT 102
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2561
Mailing Address - Country:US
Mailing Address - Phone:240-714-8465
Mailing Address - Fax:
Practice Address - Street 1:5646 WHITFIELD CHAPEL RD APT 102
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2561
Practice Address - Country:US
Practice Address - Phone:240-714-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN500014195163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health