Provider Demographics
NPI:1952661456
Name:MINYEM, MARIE DEPAZY
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DEPAZY
Last Name:MINYEM
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 1:6731 NEW HAMPSHIRE AVE
Mailing Address - Street 2:APT 409
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4863
Mailing Address - Country:US
Mailing Address - Phone:240-501-6418
Mailing Address - Fax:
Practice Address - Street 1:6731 NEW HAMPSHIRE AVE
Practice Address - Street 2:APT 409
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4863
Practice Address - Country:US
Practice Address - Phone:240-501-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1751058037766374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide