Provider Demographics
NPI:1497489983
Name:KOUAYI, GILLINE
Entity Type:Individual
Prefix:
First Name:GILLINE
Middle Name:
Last Name:KOUAYI
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 1:6436 BRIGHTLEA DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2850
Mailing Address - Country:US
Mailing Address - Phone:240-646-2109
Mailing Address - Fax:
Practice Address - Street 1:721 48TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3607
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00134641376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide