Provider Demographics
NPI:1346796893
Name:JAZE NYONTA, CHRISTELLE NADEGE
Entity Type:Individual
Prefix:
First Name:CHRISTELLE NADEGE
Middle Name:
Last Name:JAZE NYONTA
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 1:1022 QUEBEC TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3128
Mailing Address - Country:US
Mailing Address - Phone:571-469-3663
Mailing Address - Fax:
Practice Address - Street 1:1022 QUEBEC TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3128
Practice Address - Country:US
Practice Address - Phone:571-469-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12317374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide