MEDICARE: JEAN MBOUWE

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	172V00000X	Community Health Worker
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1881956605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MBOUWE

Provider Business Mailing Address
First Line	:	23 RIGGS RD NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2461
Country	:	US
Telephone Number	:	240-640-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 VARNUM ST NE STE 241
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2144
Country	:	US
Telephone Number	:	202-526-2400
Fax Number	:

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

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	07/26/2023

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Directions to “ JEAN MBOUWE ” Practice Location

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