Provider Demographics
NPI:1427401470
Name:MOUSSONGA BAKINEN EPS, BERNADETTE
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MOUSSONGA BAKINEN EPS
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 1:3261 QUEENSTOWN DR
Mailing Address - Street 2:APT. 202
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1075
Mailing Address - Country:US
Mailing Address - Phone:301-768-0493
Mailing Address - Fax:
Practice Address - Street 1:3261 QUEENSTOWN DR
Practice Address - Street 2:APT. 202
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1075
Practice Address - Country:US
Practice Address - Phone:301-768-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12233374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide