Provider Demographics
NPI:1447937818
Name:YEMATA, NGOUAGNIA NADEGE
Entity type:Individual
Prefix:
First Name:NGOUAGNIA
Middle Name:NADEGE
Last Name:YEMATA
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 1:7421 LEAHY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3661
Mailing Address - Country:US
Mailing Address - Phone:240-886-8526
Mailing Address - Fax:
Practice Address - Street 1:7421 LEAHY RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3661
Practice Address - Country:US
Practice Address - Phone:240-886-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002909374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide