Provider Demographics
NPI:1114788718
Name:PENOUONEPOU YUOPUO, NIQUETTE (CNA)
Entity type:Individual
Prefix:
First Name:NIQUETTE
Middle Name:
Last Name:PENOUONEPOU YUOPUO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 GREENWICH WOOD DR APT 14
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2109
Mailing Address - Country:US
Mailing Address - Phone:301-844-1699
Mailing Address - Fax:
Practice Address - Street 1:1802 GREENWICH WOOD DR APT 14
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2108
Practice Address - Country:US
Practice Address - Phone:301-844-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MD3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide