1548622939 NPI number — LOVELINE NJUKANG MENTONGA RN

Table of content: MRS. AMINATA SESAY-MBAYO NP (NPI 1538609227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548622939 NPI number — LOVELINE NJUKANG MENTONGA RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENTONGA
Provider First Name:
LOVELINE
Provider Middle Name:
NJUKANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MENTONGA
Provider Other First Name:
LOVELINE
Provider Other Middle Name:
NJUKANG
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMHNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548622939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11102 OLD YORK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-2228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-696-9066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 PENNSYLVANIA AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-878-6626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN1040182 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NP1040182 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)