Provider Demographics
NPI:1396418620
Name:TCHOUNGUIN, CHRISTELLE VIRGINIA
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:VIRGINIA
Last Name:TCHOUNGUIN
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 1:6604 W FOREST RD APT 201
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1751
Mailing Address - Country:US
Mailing Address - Phone:859-457-3524
Mailing Address - Fax:
Practice Address - Street 1:6604 W FOREST RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-1751
Practice Address - Country:US
Practice Address - Phone:859-457-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide