Provider Demographics
NPI:1821546805
Name:ATABONGLEKE, LOUISA
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:ATABONGLEKE
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 1:6002 CAMILLO CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3522
Mailing Address - Country:US
Mailing Address - Phone:240-825-6348
Mailing Address - Fax:
Practice Address - Street 1:6002 CAMILLO CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3522
Practice Address - Country:US
Practice Address - Phone:240-825-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12367390200000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program