Provider Demographics
NPI:1104685114
Name:GOSSE, AIMEE-MARCELLE DJOMLON
Entity type:Individual
Prefix:
First Name:AIMEE-MARCELLE
Middle Name:DJOMLON
Last Name:GOSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIMEE MARCELLE
Other - Middle Name:DJOMLON
Other - Last Name:GOSSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:853 21ST ST NE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4141
Mailing Address - Country:US
Mailing Address - Phone:202-393-9166
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2696
Practice Address - Country:US
Practice Address - Phone:202-660-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1039984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health