Provider Demographics
NPI:1417832429
Name:KENGNI EPSE SOH, MARIE PASCAL
Entity type:Individual
Prefix:
First Name:MARIE PASCAL
Middle Name:
Last Name:KENGNI EPSE SOH
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 1:8715 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3556
Mailing Address - Country:US
Mailing Address - Phone:240-615-0961
Mailing Address - Fax:
Practice Address - Street 1:8715 1ST AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3556
Practice Address - Country:US
Practice Address - Phone:240-615-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200005241374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide