Provider Demographics
NPI:1730664541
Name:YUMBOUANG, JULIENNE
Entity Type:Individual
Prefix:
First Name:JULIENNE
Middle Name:
Last Name:YUMBOUANG
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 1:901 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1403
Mailing Address - Country:US
Mailing Address - Phone:240-528-0053
Mailing Address - Fax:202-282-3109
Practice Address - Street 1:901 1ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1403
Practice Address - Country:US
Practice Address - Phone:240-528-0053
Practice Address - Fax:202-282-3109
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14222374U00000X
MDA00082416376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00082416OtherCNA- GERIATRIC NURSING ASSISTANT