Provider Demographics
NPI:1124380837
Name:EJOLLE, ANDREW ATABE
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ATABE
Last Name:EJOLLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 CHILLUM RD
Mailing Address - Street 2:APT 302
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1083
Mailing Address - Country:US
Mailing Address - Phone:202-812-7372
Mailing Address - Fax:
Practice Address - Street 1:3236 CHILLUM RD
Practice Address - Street 2:APT 302
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1083
Practice Address - Country:US
Practice Address - Phone:202-812-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide