Healthcare Provider Details

I. General information

NPI: 1154681005
Provider Name (Legal Business Name): DESIREE CLEMENCE DEUTCHOUA HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 LANETTE LN
GLENN DALE MD
20769-9225
US

IV. Provider business mailing address

11205 LANETTE LN
GLENN DALE MD
20769-9225
US

V. Phone/Fax

Practice location:
  • Phone: 240-429-2427
  • Fax:
Mailing address:
  • Phone: 240-429-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN1057334
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: