Provider Demographics
NPI:1770155418
Name:DZEMO NGUEDJIE, DESMONE
Entity type:Individual
Prefix:
First Name:DESMONE
Middle Name:
Last Name:DZEMO NGUEDJIE
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 1:11700 OLD COLUMBIA PIKE APT 504
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2552
Mailing Address - Country:US
Mailing Address - Phone:301-408-8476
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE APT 504
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2552
Practice Address - Country:US
Practice Address - Phone:301-408-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20212193374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide