Healthcare Provider Details

I. General information

NPI: 1982214557
Provider Name (Legal Business Name): BRICE DJIKEGOUE RN (BSN)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 PARKLAWN DR STE 200
ROCKVILLE MD
20852-2669
US

IV. Provider business mailing address

11900 PARKLAWN DR STE 200
ROCKVILLE MD
20852-2669
US

V. Phone/Fax

Practice location:
  • Phone: 301-500-6145
  • Fax: 240-332-8787
Mailing address:
  • Phone: 301-500-6145
  • Fax: 240-332-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR4768P
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: