Provider Demographics
NPI:1033470869
Name:DE YOUMTO, MARIE FLORENCE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:FLORENCE
Last Name:DE YOUMTO
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 1:1234 SOTHERN AVENUE SOUTH EAST
Mailing Address - Street 2:#301
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:202-704-4271
Mailing Address - Fax:
Practice Address - Street 1:1234 SOUTHERN AVENUE SOUTH EAST
Practice Address - Street 2:#301
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-704-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker