Provider Demographics
NPI:1497014567
Name:DOUKOURE, ASSA
Entity Type:Individual
Prefix:
First Name:ASSA
Middle Name:
Last Name:DOUKOURE
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 1:6735 NEW HAMPSHIRE AVE
Mailing Address - Street 2:#306E
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4865
Mailing Address - Country:US
Mailing Address - Phone:240-550-0081
Mailing Address - Fax:
Practice Address - Street 1:6735 NEW HAMPSHIRE AVE
Practice Address - Street 2:#306E
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4865
Practice Address - Country:US
Practice Address - Phone:240-550-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD260072019554374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide