Healthcare Provider Details

I. General information

NPI: 1699039057
Provider Name (Legal Business Name): VIVIANE FLORA DICOUM NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SECURITY BLVD STE 200
BALTIMORE MD
21244-2412
US

IV. Provider business mailing address

8604 BRIARWOOD CT
LAUREL MD
20708-1320
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax: 202-722-7785
Mailing address:
  • Phone: 301-256-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR212329
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: