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General NPI Number Information
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NPI Number | 1699039057
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Entity Type | Individual
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Provider Name | VIVIANE DICOUM NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/01/2012
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 7826 EASTERN AVE NW LL18A
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City | WASHINGTON
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State | DC
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Zip | 20012-1324
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Country | US
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Telephone | 202-722-7776
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Fax | 202-722-7785
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Provider Business Mailing Address
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Address Line | 8604 BRIARWOOD CT
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City | LAUREL
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State | MD
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Zip | 20708-1320
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Country | US
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Telephone | 240-765-4918
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R212329
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License Number State | MD
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