Provider Demographics
NPI:1679945042
Name:NGOUNOU, ODETTE KENGNE
Entity type:Individual
Prefix:
First Name:ODETTE
Middle Name:KENGNE
Last Name:NGOUNOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6219
Mailing Address - Country:US
Mailing Address - Phone:240-704-3195
Mailing Address - Fax:
Practice Address - Street 1:8302 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6219
Practice Address - Country:US
Practice Address - Phone:240-704-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA410749374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide