MEDICARE: DESIREE CLEMENCE DEUTCHOUA HHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	RN1057334	DC
2	171M00000X	Case Manager/Care Coordinator
3	374U00000X	Home Health Aide
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1154681005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE CLEMENCE DEUTCHOUA HHA

Provider Business Mailing Address
First Line	:	11205 LANETTE LN
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9225
Country	:	US
Telephone Number	:	240-429-2427
Fax Number	:

Provider Business Practice Location Address
First Line	:	11205 LANETTE LN
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9225
Country	:	US
Telephone Number	:	240-429-2427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	03/21/2025

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