Provider Demographics
NPI:1710310123
Name:NJOMBA EPSE WANTEU, ANTOINNETTE NJOMBA BEATRICE
Entity Type:Individual
Prefix:
First Name:ANTOINNETTE
Middle Name:NJOMBA BEATRICE
Last Name:NJOMBA EPSE WANTEU
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 1:115 MISSOURI AVE#4 NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONG
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:240-704-4556
Mailing Address - Fax:
Practice Address - Street 1:115 MISSOURI AVE NW APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5241
Practice Address - Country:US
Practice Address - Phone:240-704-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide