Provider Demographics
NPI:1396397212
Name:HOTOU MEJONANG, SYNTICHE (HHA)
Entity Type:Individual
Prefix:
First Name:SYNTICHE
Middle Name:
Last Name:HOTOU MEJONANG
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 COLUMBIA RD APT 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5590
Mailing Address - Country:US
Mailing Address - Phone:804-550-8337
Mailing Address - Fax:
Practice Address - Street 1:5609 COLUMBIA RD APT 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-5590
Practice Address - Country:US
Practice Address - Phone:804-550-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14106374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty