Provider Demographics
NPI:1619543956
Name:BOUNGUE, SOLENN
Entity Type:Individual
Prefix:
First Name:SOLENN
Middle Name:
Last Name:BOUNGUE
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 1:11240 EVANS TRL APT 103
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3923
Mailing Address - Country:US
Mailing Address - Phone:240-533-6253
Mailing Address - Fax:
Practice Address - Street 1:11240 EVANS TRL APT 103
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3923
Practice Address - Country:US
Practice Address - Phone:240-533-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20203332376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide