Provider Demographics
NPI:1730952284
Name:NKEMATEH, NICOLE FOLEFAC
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FOLEFAC
Last Name:NKEMATEH
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 1:3014 WINTERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9105
Mailing Address - Country:US
Mailing Address - Phone:240-524-8688
Mailing Address - Fax:
Practice Address - Street 1:1427 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5614
Practice Address - Country:US
Practice Address - Phone:202-836-4841
Practice Address - Fax:202-836-4842
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker