Provider Demographics
NPI:1700628989
Name:KENFACK SOADEU, CHRISTELLE K
Entity type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:K
Last Name:KENFACK SOADEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTELLE
Other - Middle Name:K
Other - Last Name:KENFACK SOADEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8904 ASCOT LN APT 31
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1571
Mailing Address - Country:US
Mailing Address - Phone:301-979-1582
Mailing Address - Fax:
Practice Address - Street 1:702 15TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4508
Practice Address - Country:US
Practice Address - Phone:202-388-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker