Provider Demographics
NPI:1376295006
Name:CHE, JULLETTE NGUM
Entity Type:Individual
Prefix:
First Name:JULLETTE
Middle Name:NGUM
Last Name:CHE
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 1:734 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5953
Mailing Address - Country:US
Mailing Address - Phone:202-940-3606
Mailing Address - Fax:
Practice Address - Street 1:734 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5953
Practice Address - Country:US
Practice Address - Phone:202-940-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA200001500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide