Provider Demographics
NPI:1407330749
Name:PATIPE NOUMBISSIE, DUPLEX
Entity Type:Individual
Prefix:
First Name:DUPLEX
Middle Name:
Last Name:PATIPE NOUMBISSIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SARGENT RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2861
Mailing Address - Country:US
Mailing Address - Phone:202-517-5497
Mailing Address - Fax:
Practice Address - Street 1:5120 SARGENT RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2861
Practice Address - Country:US
Practice Address - Phone:202-517-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC13967374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide