Provider Demographics
NPI:1720664451
Name:DEUSSOM, JEANNE CHANTAL
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:CHANTAL
Last Name:DEUSSOM
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 1:1516 CHILLUM RD APT 3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2444
Mailing Address - Country:US
Mailing Address - Phone:240-614-8807
Mailing Address - Fax:
Practice Address - Street 1:1516 CHILLUM RD APT 3
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2444
Practice Address - Country:US
Practice Address - Phone:240-614-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide