Healthcare Provider Details

I. General information

NPI: 1558162164
Provider Name (Legal Business Name): IRENE NANA DJOMGOUE DJAMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18815 WALKERS CHOICE RD
MONTGOMERY VILLAGE MD
20886-0606
US

IV. Provider business mailing address

18815 WALKERS CHOICE RD
MONTGOMERY VILLAGE MD
20886-0606
US

V. Phone/Fax

Practice location:
  • Phone: 240-676-6580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200004515
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: