Provider Demographics
NPI:1265804504
Name:MUSONG, FLAVIE (HHA)
Entity type:Individual
Prefix:MISS
First Name:FLAVIE
Middle Name:
Last Name:MUSONG
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 TREXLER RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3776
Mailing Address - Country:US
Mailing Address - Phone:240-495-9446
Mailing Address - Fax:
Practice Address - Street 1:6805 TREXLER RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3776
Practice Address - Country:US
Practice Address - Phone:240-495-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11545374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide