Provider Demographics
NPI:1457604894
Name:BOUJEKE TCHOMTE, ADELINE LAURE
Entity Type:Individual
Prefix:
First Name:ADELINE LAURE
Middle Name:
Last Name:BOUJEKE TCHOMTE
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 1:11935 164TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5738
Mailing Address - Country:US
Mailing Address - Phone:347-585-0786
Mailing Address - Fax:
Practice Address - Street 1:11935 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5738
Practice Address - Country:US
Practice Address - Phone:347-585-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657102-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse