Healthcare Provider Details

I. General information

NPI: 1770155418
Provider Name (Legal Business Name): DESMONE DZEMO NGUEDJIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 OLD COLUMBIA PIKE APT 504
SILVER SPRING MD
20904-2552
US

IV. Provider business mailing address

11700 OLD COLUMBIA PIKE APT 504
SILVER SPRING MD
20904-2552
US

V. Phone/Fax

Practice location:
  • Phone: 301-408-8476
  • Fax:
Mailing address:
  • Phone: 301-408-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA20212193
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: