Healthcare Provider Details

I. General information

NPI: 1699967596
Provider Name (Legal Business Name): VIVIANE DJOMKAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 FOX RUN DR APT 102
CINCINNATI OH
45236-1146
US

IV. Provider business mailing address

3795 FOX RUN DR APT 102
CINCINNATI OH
45236-1146
US

V. Phone/Fax

Practice location:
  • Phone: 513-373-4242
  • Fax:
Mailing address:
  • Phone: 513-373-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN. 329191
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: