Provider Demographics
NPI:1417216698
Name:POKAM WANDA, BRIGITTE PAULINE (HHA)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:PAULINE
Last Name:POKAM WANDA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:MRS
Other - First Name:PAULINE
Other - Middle Name:BRIGITTE
Other - Last Name:POKAM WANDA NGOBAMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HHA
Mailing Address - Street 1:6735 NEW HAMPSHIRE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:240-413-8619
Mailing Address - Fax:
Practice Address - Street 1:6735 NEW HAMPSHIRE AVE APT 301
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2867
Practice Address - Country:US
Practice Address - Phone:240-413-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC62407374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide