Provider Demographics
NPI:1376976779
Name:SOUMAH, MEMOUNATOU
Entity Type:Individual
Prefix:
First Name:MEMOUNATOU
Middle Name:
Last Name:SOUMAH
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 1:3307 BEECHCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-5103
Mailing Address - Country:US
Mailing Address - Phone:571-435-2073
Mailing Address - Fax:571-435-2073
Practice Address - Street 1:3307 BEECHCLIFF DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-5103
Practice Address - Country:US
Practice Address - Phone:571-435-2073
Practice Address - Fax:571-435-2073
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide