Provider Demographics
NPI:1669265633
Name:EMENAYOM, BERNADETTE NGOZI
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:NGOZI
Last Name:EMENAYOM
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 1:10904 TYRONE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4635
Mailing Address - Country:US
Mailing Address - Phone:240-739-4294
Mailing Address - Fax:
Practice Address - Street 1:10904 TYRONE DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4635
Practice Address - Country:US
Practice Address - Phone:240-739-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide