Provider Demographics
NPI:1629653795
Name:TEKE EPSE NKOUAMI, ROSE NDUM
Entity Type:Individual
Prefix:
First Name:ROSE NDUM
Middle Name:
Last Name:TEKE EPSE NKOUAMI
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 1:7401 NEW HAMPSHIRE AVE APT 1110
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6955
Mailing Address - Country:US
Mailing Address - Phone:240-553-4250
Mailing Address - Fax:
Practice Address - Street 1:7401 NEW HAMPSHIRE AVE APT 1110
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6955
Practice Address - Country:US
Practice Address - Phone:240-553-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15695374U00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide