Provider Demographics
NPI:1346744141
Name:SIEWE MBOUWE, JACQUES VANEL
Entity Type:Individual
Prefix:
First Name:JACQUES VANEL
Middle Name:
Last Name:SIEWE MBOUWE
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 1:3508 COMMODORE JOSHUA BARNEY DR NE APT T3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4409
Mailing Address - Country:US
Mailing Address - Phone:202-290-9578
Mailing Address - Fax:
Practice Address - Street 1:3508 COMMODORE JOSHUA BARNEY DRIVE N.E
Practice Address - Street 2:APT #T3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-290-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12937374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide