Provider Demographics
NPI:1245674266
Name:KENMOGNE, CYRILLE CHANTALE
Entity type:Individual
Prefix:
First Name:CYRILLE
Middle Name:CHANTALE
Last Name:KENMOGNE
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 1:1812 METZEROTT RD
Mailing Address - Street 2:APT 41
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5150
Mailing Address - Country:US
Mailing Address - Phone:301-640-1885
Mailing Address - Fax:
Practice Address - Street 1:1812 METZEROTT RD
Practice Address - Street 2:APT 41
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5150
Practice Address - Country:US
Practice Address - Phone:301-640-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide