Provider Demographics
NPI:1134893266
Name:DJUNKEP, ELISE LOVELINE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:LOVELINE
Last Name:DJUNKEP
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 1:3922 BLACKBURN LN APT 13
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1265
Mailing Address - Country:US
Mailing Address - Phone:917-774-1381
Mailing Address - Fax:
Practice Address - Street 1:3922 BLACKBURN LN APT 13
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1265
Practice Address - Country:US
Practice Address - Phone:917-774-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00166533376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide