Provider Demographics
NPI:1881956605
Name:MBOUWE, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MBOUWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIGGS RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2461
Mailing Address - Country:US
Mailing Address - Phone:240-640-3838
Mailing Address - Fax:
Practice Address - Street 1:817 VARNUM ST NE STE 241
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2144
Practice Address - Country:US
Practice Address - Phone:202-526-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker