Provider Demographics
NPI:1851946065
Name:MENGUE OBOUGOU, PAULINE NADINE
Entity Type:Individual
Prefix:
First Name:PAULINE NADINE
Middle Name:
Last Name:MENGUE OBOUGOU
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 1:3025 ONTARIO RD NW APT B1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6035
Mailing Address - Country:US
Mailing Address - Phone:240-413-0926
Mailing Address - Fax:
Practice Address - Street 1:3025 ONTARIO RD NW APT B1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6035
Practice Address - Country:US
Practice Address - Phone:240-413-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14599374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide