Provider Demographics
NPI:1477078533
Name:NEBOPOULET EPSE KOUNGOU, SOLANGE
Entity Type:Individual
Prefix:
First Name:SOLANGE
Middle Name:
Last Name:NEBOPOULET EPSE KOUNGOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOLANGE
Other - Middle Name:
Other - Last Name:KOUNGOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9144 EDMONSTON RD APT 301
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4393
Mailing Address - Country:US
Mailing Address - Phone:240-645-5667
Mailing Address - Fax:
Practice Address - Street 1:9144 EDMONSTON RD APT 301
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4393
Practice Address - Country:US
Practice Address - Phone:240-645-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide