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General NPI Number Information
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NPI Number | 1710338546
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Entity Type | Individual
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Provider Name | MENO MAZEMDA KOUAKEU NP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 1201 S HAYES ST
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City | ARLINGTON
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State | VA
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Zip | 22202-2700
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Country | US
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Telephone | 757-292-9094
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 1ST ST SW
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City | WASHINGTON
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State | DC
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Zip | 20032-1304
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Country | US
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Telephone | 757-292-9094
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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 | 0024173643
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024173643
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License Number State | VA
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