Provider Demographics
NPI:1063908366
Name:YOUMSSI FOTSO, ISABELLE JUDITH
Entity type:Individual
Prefix:
First Name:ISABELLE JUDITH
Middle Name:
Last Name:YOUMSSI FOTSO
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 1:6813 RIGGS MANOR DR APT 304
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-6923
Mailing Address - Country:US
Mailing Address - Phone:646-983-6071
Mailing Address - Fax:
Practice Address - Street 1:6813 RIGGS MANOR DR APT 304
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-6923
Practice Address - Country:US
Practice Address - Phone:646-983-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13781374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide