Provider Demographics
NPI:1982214557
Name:DJIKEGOUE, BRICE (RN (BSN))
Entity Type:Individual
Prefix:MR
First Name:BRICE
Middle Name:
Last Name:DJIKEGOUE
Suffix:
Gender:M
Credentials:RN (BSN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 PARKLAWN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2669
Mailing Address - Country:US
Mailing Address - Phone:301-500-6145
Mailing Address - Fax:240-332-8787
Practice Address - Street 1:11900 PARKLAWN DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2669
Practice Address - Country:US
Practice Address - Phone:301-500-6145
Practice Address - Fax:240-332-8787
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4768P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health