Provider Demographics
NPI:1952992364
Name:DABO EPSE TELLA TAGNE, ALPHONCINE L
Entity Type:Individual
Prefix:
First Name:ALPHONCINE
Middle Name:L
Last Name:DABO EPSE TELLA TAGNE
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 1:908 ATLEE DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5959
Mailing Address - Country:US
Mailing Address - Phone:240-487-8497
Mailing Address - Fax:
Practice Address - Street 1:908 ATLEE DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5959
Practice Address - Country:US
Practice Address - Phone:240-487-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00177795Medicaid