Provider Demographics
NPI:1518446657
Name:DOMCHE - PESOK, FLORENTINE MADELEINE
Entity Type:Individual
Prefix:
First Name:FLORENTINE
Middle Name:MADELEINE
Last Name:DOMCHE - PESOK
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 1:1836 METZEROTT RD APT 1116
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3449
Mailing Address - Country:US
Mailing Address - Phone:240-481-0259
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT 1116
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:240-481-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13375374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide