Provider Demographics
NPI:1972865913
Name:TCHOUMGOU, KENNI ELEONORE-NADEGE
Entity Type:Individual
Prefix:
First Name:KENNI
Middle Name:ELEONORE-NADEGE
Last Name:TCHOUMGOU
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 1:11200 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4551
Mailing Address - Country:US
Mailing Address - Phone:240-274-5047
Mailing Address - Fax:
Practice Address - Street 1:11200 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4551
Practice Address - Country:US
Practice Address - Phone:240-274-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide