Provider Demographics
NPI:1932667649
Name:TCHEUFFA HAMAKOUA, MICHELLE VIANNEY
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VIANNEY
Last Name:TCHEUFFA HAMAKOUA
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 1:1200 MYRTLE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6510
Mailing Address - Country:US
Mailing Address - Phone:240-533-1606
Mailing Address - Fax:
Practice Address - Street 1:1200 MYRTLE AVE APT 101
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6510
Practice Address - Country:US
Practice Address - Phone:240-533-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14332374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide