Provider Demographics
NPI:1881204592
Name:NGO SAMBAN EPSE EMMEH, DEBORA BLANDINE
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:BLANDINE
Last Name:NGO SAMBAN EPSE EMMEH
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 1:6733 NEW HAMPSHIRE AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2842
Mailing Address - Country:US
Mailing Address - Phone:240-423-6780
Mailing Address - Fax:
Practice Address - Street 1:6733 NEW HAMPSHIRE AVE APT 309
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2842
Practice Address - Country:US
Practice Address - Phone:240-423-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15089374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide