Provider Demographics
NPI:1255691754
Name:KOANOU, MARTHE FOUONDZING
Entity Type:Individual
Prefix:
First Name:MARTHE
Middle Name:FOUONDZING
Last Name:KOANOU
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 1:1814 IRVING ST NW
Mailing Address - Street 2:#301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2615
Mailing Address - Country:US
Mailing Address - Phone:202-247-7762
Mailing Address - Fax:
Practice Address - Street 1:1814 IRVING ST NW
Practice Address - Street 2:#301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2615
Practice Address - Country:US
Practice Address - Phone:202-247-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide