Healthcare Provider Details

I. General information

NPI: 1356922033
Provider Name (Legal Business Name): MIREILLE KUIGOUA TCHAKOUNTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6357 64TH AVE # F7
RIVERDALE MD
20737-1501
US

IV. Provider business mailing address

6357 64TH AVE # F7
RIVERDALE MD
20737-1501
US

V. Phone/Fax

Practice location:
  • Phone: 240-470-4869
  • Fax:
Mailing address:
  • Phone: 240-470-4869
  • 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: