Healthcare Provider Details

I. General information

NPI: 1710310123
Provider Name (Legal Business Name): ANTOINNETTE NJOMBA BEATRICE NJOMBA EPSE WANTEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MISSOURI AVE NW APT 4
WASHINGTON DC
20011-5241
US

IV. Provider business mailing address

115 MISSOURI AVE#4 NW
WASHINGTONG DC
20011
US

V. Phone/Fax

Practice location:
  • Phone: 240-704-4556
  • Fax:
Mailing address:
  • Phone: 240-704-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: