Provider Demographics
NPI:1114788718
Name:PENOUONEPOU YUOPUO, NIQUETTE (CNA)
Entity Type:Individual
Prefix:
First Name:NIQUETTE
Middle Name:
Last Name:PENOUONEPOU YUOPUO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 TAYSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4769
Mailing Address - Country:US
Mailing Address - Phone:301-844-1699
Mailing Address - Fax:
Practice Address - Street 1:389 TAYSIDE WAY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4769
Practice Address - Country:US
Practice Address - Phone:301-844-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide