Provider Demographics
NPI:1669057170
Name:SIME YEPMO, ELIANE NATHALIE
Entity type:Individual
Prefix:
First Name:ELIANE NATHALIE
Middle Name:
Last Name:SIME YEPMO
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 1:9773 GOOD LUCK RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3335
Mailing Address - Country:US
Mailing Address - Phone:240-593-6484
Mailing Address - Fax:
Practice Address - Street 1:9773 GOOD LUCK RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3335
Practice Address - Country:US
Practice Address - Phone:240-593-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20210443Medicaid