Provider Demographics
NPI:1043806052
Name:BERTHELINE EMILIE EPSE TCHAKOUNTE, MONKAM DEUDJEU
Entity Type:Individual
Prefix:
First Name:MONKAM
Middle Name:DEUDJEU
Last Name:BERTHELINE EMILIE EPSE TCHAKOUNTE
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 1:6543 PENNSYLVANIA AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3045
Mailing Address - Country:US
Mailing Address - Phone:240-598-8378
Mailing Address - Fax:
Practice Address - Street 1:6543 PENNSYLVANIA AVE APT 204
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3045
Practice Address - Country:US
Practice Address - Phone:240-598-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20202312374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide