Provider Demographics
NPI:1871298919
Name:KENFACK, DANNY YOLANDE
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:YOLANDE
Last Name:KENFACK
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 1:2905 MUESERBUSH CT
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-5524
Mailing Address - Country:US
Mailing Address - Phone:443-675-8602
Mailing Address - Fax:
Practice Address - Street 1:2905 MUESERBUSH CT
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-5524
Practice Address - Country:US
Practice Address - Phone:443-675-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251S00000X
DCLPN200002618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health