Provider Demographics
NPI:1831720986
Name:DJOMENI EPSE TITCHOM, MARIE NIC EPSE
Entity type:Individual
Prefix:
First Name:MARIE NIC
Middle Name:EPSE
Last Name:DJOMENI EPSE TITCHOM
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 1:11422 STEWART LN APT C2
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2200
Mailing Address - Country:US
Mailing Address - Phone:240-601-1284
Mailing Address - Fax:
Practice Address - Street 1:11422 STEWART LN APT C2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2200
Practice Address - Country:US
Practice Address - Phone:240-601-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide