Provider Demographics
NPI:1063780005
Name:JOUKWE, ELVIS DJEMO (RN, BSN)
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:DJEMO
Last Name:JOUKWE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 MORRISON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9093
Mailing Address - Country:US
Mailing Address - Phone:614-577-0475
Mailing Address - Fax:
Practice Address - Street 1:1659 MORRISON FARMS DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9093
Practice Address - Country:US
Practice Address - Phone:614-577-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.369522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse