=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043806052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONKAM DEUDJEU BERTHELINE EMILIE EPSE TCHAKOUNTE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2020
-----------------------------------------------------
Last Update Date | 05/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6543 PENNSYLVANIA AVE APT 204
-----------------------------------------------------
City | DISTRICT HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-598-8378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6543 PENNSYLVANIA AVE APT 204
-----------------------------------------------------
City | DISTRICT HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-598-8378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | CNA20202312
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | CNA20202312
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HHA200003742
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------