Provider Demographics
NPI:1104180272
Name:TAMBOUA, MARCELLINE TYHO
Entity Type:Individual
Prefix:
First Name:MARCELLINE
Middle Name:TYHO
Last Name:TAMBOUA
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 1:601 EDGEWOOD ST NE
Mailing Address - Street 2:APT 536
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3314
Mailing Address - Country:US
Mailing Address - Phone:202-271-9935
Mailing Address - Fax:
Practice Address - Street 1:601 EDGEWOOD ST NE
Practice Address - Street 2:APT 536
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3314
Practice Address - Country:US
Practice Address - Phone:202-271-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide