Provider Demographics
NPI:1295406940
Name:DJOSSOU, ANSELME (RN)
Entity Type:Individual
Prefix:
First Name:ANSELME
Middle Name:
Last Name:DJOSSOU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ASH ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4501
Mailing Address - Country:US
Mailing Address - Phone:978-319-7367
Mailing Address - Fax:
Practice Address - Street 1:101 ASH ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4501
Practice Address - Country:US
Practice Address - Phone:978-319-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2352635163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty