Provider Demographics
NPI:1568136091
Name:YILLAH, ROUGIATOU D
Entity Type:Individual
Prefix:
First Name:ROUGIATOU
Middle Name:D
Last Name:YILLAH
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 1:7613 RIVERDALE RD APT 113
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3736
Mailing Address - Country:US
Mailing Address - Phone:571-232-5195
Mailing Address - Fax:
Practice Address - Street 1:7613 RIVERDALE RD APT 113
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3736
Practice Address - Country:US
Practice Address - Phone:571-232-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00174268376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide