Healthcare Provider Details

I. General information

NPI: 1225503345
Provider Name (Legal Business Name): ORELIE YMDJU KOUNOUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 KENNEDY ST NW
WASHINGTON DC
20011-2913
US

IV. Provider business mailing address

11700 OLD COLUMBIA PIKE APT 511
SILVER SPRING MD
20904-2553
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 TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13974
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: