Provider Demographics
NPI:1861241853
Name:NGOUEM, JACOBINE ROSE
Entity type:Individual
Prefix:MS
First Name:JACOBINE
Middle Name:ROSE
Last Name:NGOUEM
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 1:11512 STEWART LN APT C211512
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2237
Mailing Address - Country:US
Mailing Address - Phone:240-424-6640
Mailing Address - Fax:
Practice Address - Street 1:11512 STEWART LN APT C2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2237
Practice Address - Country:US
Practice Address - Phone:240-424-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide