Provider Demographics
NPI:1063001899
Name:TASSEKE EPSE BATCHONA, PYALOU
Entity Type:Individual
Prefix:MISS
First Name:PYALOU
Middle Name:
Last Name:TASSEKE EPSE BATCHONA
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 1:909 LONGFELLOW ST NW APT 206
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-8243
Mailing Address - Country:US
Mailing Address - Phone:202-509-4308
Mailing Address - Fax:
Practice Address - Street 1:909 LONGFELLOW ST NW APT 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-8243
Practice Address - Country:US
Practice Address - Phone:202-509-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20203561376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide