Healthcare Provider Details

I. General information

NPI: 1831448075
Provider Name (Legal Business Name): MISS MARIE MIREILLE TJOMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 HEWITT AVE APT 104
SILVER SPRING MD
20906-5405
US

IV. Provider business mailing address

3402 HEWITT AVE APT 104
SILVER SPRING MD
20906-5405
US

V. Phone/Fax

Practice location:
  • Phone: 240-640-9052
  • Fax:
Mailing address:
  • Phone: 240-640-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: