MEDICARE: MARIE THERESE DENISE NGASSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA12058	DC

General Provider Information

NPI Number	:	1811343783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE THERESE DENISE NGASSA

Provider Business Mailing Address
First Line	:	4516 FORT TOTTEN DR NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 FORT TOTTEN DR NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7523
Country	:	US
Telephone Number	:	202-848-0829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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