Provider Demographics
NPI:1649731563
Name:KAMGANG-NOUBISSI, HENRIETTE N (NP)
Entity type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:N
Last Name:KAMGANG-NOUBISSI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19731 EXECUTIVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2642
Mailing Address - Country:US
Mailing Address - Phone:301-540-1332
Mailing Address - Fax:
Practice Address - Street 1:9318 GAITHER RD STE 205
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1409
Practice Address - Country:US
Practice Address - Phone:301-820-7200
Practice Address - Fax:301-778-7026
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily