Provider Demographics
NPI:1114405719
Name:AYIBISSE, ROSE MEKOK
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MEKOK
Last Name:AYIBISSE
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 1:6928 WALKER MILL RD APT D2
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-7603
Mailing Address - Country:US
Mailing Address - Phone:301-538-2493
Mailing Address - Fax:
Practice Address - Street 1:6928 WALKER MILL RD APT D2
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-7603
Practice Address - Country:US
Practice Address - Phone:301-538-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC13887374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide