Provider Demographics
NPI:1336598234
Name:NDUBI LAURA, KOUMTOUDJI
Entity Type:Individual
Prefix:
First Name:KOUMTOUDJI
Middle Name:
Last Name:NDUBI LAURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:N
Other - Last Name:KOUMTOUDJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HHA/PCA
Mailing Address - Street 1:1707 L ST NW STE 900
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4208
Mailing Address - Country:US
Mailing Address - Phone:202-829-1111
Mailing Address - Fax:
Practice Address - Street 1:1707 L ST NW STE 900
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4208
Practice Address - Country:US
Practice Address - Phone:202-829-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12110374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA12110Medicaid