Provider Demographics
NPI:1396408019
Name:MATCHEWONG EPSE BOSSOMO, BRIGITTE CHANCELINE
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:CHANCELINE
Last Name:MATCHEWONG EPSE BOSSOMO
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 1:14100 WHISPERING PINES CT APT 31
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2425
Mailing Address - Country:US
Mailing Address - Phone:240-579-0498
Mailing Address - Fax:
Practice Address - Street 1:14100 WHISPERING PINES CT APT 31
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2425
Practice Address - Country:US
Practice Address - Phone:240-579-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant