Provider Demographics
NPI:1831448075
Name:TJOMB, MARIE MIREILLE
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:MIREILLE
Last Name:TJOMB
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 1:3402 HEWITT AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5405
Mailing Address - Country:US
Mailing Address - Phone:240-640-9052
Mailing Address - Fax:
Practice Address - Street 1:3402 HEWITT AVE APT 104
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5405
Practice Address - Country:US
Practice Address - Phone:240-640-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide