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General NPI Number Information
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NPI Number | 1386234706
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Entity Type | Individual
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Provider Name | CORINE MOUGOUE RN
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 10111 COLESVILLE RD STE 107
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City | SILVER SPRING
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State | MD
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Zip | 20901-2427
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Country | US
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Telephone | 610-740-4216
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Fax |
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Provider Business Mailing Address
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Address Line | 10038 JEANES ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R242884
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | R242884
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | R242884
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | R242884
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 163WC3500X
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Taxonomy Name | Cardiac Rehabilitation Registered Nurse
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License Number | R242884
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License Number State | MD
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