Provider Demographics
NPI:1003589722
Name:KPEKPASSI, RACHIDATOU
Entity Type:Individual
Prefix:
First Name:RACHIDATOU
Middle Name:
Last Name:KPEKPASSI
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 1:507 CHILLUM RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3315
Mailing Address - Country:US
Mailing Address - Phone:202-819-8111
Mailing Address - Fax:
Practice Address - Street 1:507 CHILLUM RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3315
Practice Address - Country:US
Practice Address - Phone:202-819-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00176599376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide