Provider Demographics
NPI:1053751057
Name:KEPSEU, SEVERIN LUTHER
Entity type:Individual
Prefix:
First Name:SEVERIN
Middle Name:LUTHER
Last Name:KEPSEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 QUEBEC TER
Mailing Address - Street 2:APT 1
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3139
Mailing Address - Country:US
Mailing Address - Phone:240-481-4247
Mailing Address - Fax:
Practice Address - Street 1:1029 QUEBEC TER
Practice Address - Street 2:APT 1
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3139
Practice Address - Country:US
Practice Address - Phone:240-481-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide