Provider Demographics
NPI:1366167314
Name:NARCISSE, MOUKAM POUKEN
Entity type:Individual
Prefix:
First Name:MOUKAM POUKEN
Middle Name:
Last Name:NARCISSE
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 1:2208 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3714
Mailing Address - Country:US
Mailing Address - Phone:202-857-7296
Mailing Address - Fax:
Practice Address - Street 1:2208 OVERTON DR
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3714
Practice Address - Country:US
Practice Address - Phone:202-857-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide