Healthcare Provider Details

I. General information

NPI: 1437511623
Provider Name (Legal Business Name): CLARISSE DJOUKOUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 AUTUMN BROOK AVE
SILVER SPRING MD
20906-6755
US

IV. Provider business mailing address

1404 AUTUMN BROOK AVE
SILVER SPRING MD
20906-6755
US

V. Phone/Fax

Practice location:
  • Phone: 240-439-1620
  • Fax:
Mailing address:
  • Phone:
  • 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: