Provider Demographics
NPI:1790215010
Name:MEYUM TALLA, ROSINE
Entity Type:Individual
Prefix:
First Name:ROSINE
Middle Name:
Last Name:MEYUM TALLA
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 1:84 GALVESTON ST SW APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1942
Mailing Address - Country:US
Mailing Address - Phone:240-495-4508
Mailing Address - Fax:
Practice Address - Street 1:1820 JEFFERSON PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2505
Practice Address - Country:US
Practice Address - Phone:202-299-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12769374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide