Provider Demographics
NPI:1447879994
Name:SAM, EMMANUELLA NAIN
Entity type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:NAIN
Last Name:SAM
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 1:9931 GREENBELT RD APT 203
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2222
Mailing Address - Country:US
Mailing Address - Phone:240-486-4508
Mailing Address - Fax:
Practice Address - Street 1:9931 GREENBELT RD APT 203
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2222
Practice Address - Country:US
Practice Address - Phone:240-486-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1054509163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty