Provider Demographics
NPI:1326735465
Name:BIPPE, DJOMANGA CECILIA
Entity Type:Individual
Prefix:
First Name:DJOMANGA
Middle Name:CECILIA
Last Name:BIPPE
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 1:13711 PINE NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4218
Mailing Address - Country:US
Mailing Address - Phone:301-800-3216
Mailing Address - Fax:
Practice Address - Street 1:13711 PINE NEEDLE CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4218
Practice Address - Country:US
Practice Address - Phone:301-800-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP44298164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse