Provider Demographics
NPI:1487324638
Name:POUSSEU, BLANDINE TCHIENGOUA
Entity type:Individual
Prefix:MRS
First Name:BLANDINE
Middle Name:TCHIENGOUA
Last Name:POUSSEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLANDINE
Other - Middle Name:T
Other - Last Name:NGUEFANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:62 BOW ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1166
Mailing Address - Country:US
Mailing Address - Phone:781-309-2640
Mailing Address - Fax:
Practice Address - Street 1:585 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3225
Practice Address - Country:US
Practice Address - Phone:781-534-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health