Healthcare Provider Details

I. General information

NPI: 1184190068
Provider Name (Legal Business Name): PRINETTE NZELLE PALLE EPSE SONE EPIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 KENNEDY ST NW
WASHINGTON DC
20011-2913
US

IV. Provider business mailing address

6813 W FOREST RD
HYATTSVILLE MD
20785-3332
US

V. Phone/Fax

Practice location:
  • Phone: 202-558-6084
  • Fax: 202-722-1726
Mailing address:
  • Phone: 202-722-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14046
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: