Healthcare Provider Details

I. General information

NPI: 1588318687
Provider Name (Legal Business Name): MIREILLE NANA NOUNKEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LOCKWOOD DR APT 1511
SILVER SPRING MD
20901-4544
US

IV. Provider business mailing address

11200 LOCKWOOD DR APT 1511
SILVER SPRING MD
20901-4544
US

V. Phone/Fax

Practice location:
  • Phone: 202-403-7557
  • Fax:
Mailing address:
  • Phone: 202-403-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003104
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: