Provider Demographics
NPI:1740748367
Name:MOMI KEUGOM, EMILIE SANDRINE
Entity Type:Individual
Prefix:
First Name:EMILIE SANDRINE
Middle Name:
Last Name:MOMI KEUGOM
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 1:230 LONGFELLOW ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2210
Mailing Address - Country:US
Mailing Address - Phone:202-876-7932
Mailing Address - Fax:
Practice Address - Street 1:230 LONGFELLOW ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2210
Practice Address - Country:US
Practice Address - Phone:202-876-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide