Provider Demographics
NPI:1912368028
Name:EPIE, CARINE MBOLE
Entity Type:Individual
Prefix:
First Name:CARINE
Middle Name:MBOLE
Last Name:EPIE
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 1:1806 FOX ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2352
Mailing Address - Country:US
Mailing Address - Phone:240-606-6793
Mailing Address - Fax:
Practice Address - Street 1:11414 STEWART LN APT B2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2218
Practice Address - Country:US
Practice Address - Phone:240-606-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11947251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health