MEDICARE: FLORENCE NANA KOUCHOU

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	171W00000X	Contractor	HHA8969	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396176467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE NANA KOUCHOU

Provider Business Mailing Address
First Line	:	1814 GREENWICH WOOD DR APT 23
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2123
Country	:	US
Telephone Number	:	240-552-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 GREENWICH WOOD DR APT 23
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2123
Country	:	US
Telephone Number	:	240-552-2880
Fax Number	:

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

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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Directions to “ FLORENCE NANA KOUCHOU ” Practice Location

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