Provider Demographics
NPI:1508231259
Name:MATEUBEU TAKOUAM, JEANNINE
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:MATEUBEU TAKOUAM
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 1:4107 53RD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1452
Mailing Address - Country:US
Mailing Address - Phone:202-749-1110
Mailing Address - Fax:
Practice Address - Street 1:1707 L ST NW STE 900
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4208
Practice Address - Country:US
Practice Address - Phone:202-829-1111
Practice Address - Fax:202-829-9192
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11669374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide