Provider Demographics
NPI:1326569823
Name:AGIEN, CHRISTELLE MBAYI
Entity type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:MBAYI
Last Name:AGIEN
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 1:9823 GOOD LUCK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3363
Mailing Address - Country:US
Mailing Address - Phone:240-467-8792
Mailing Address - Fax:
Practice Address - Street 1:1805 MONTANA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1859
Practice Address - Country:US
Practice Address - Phone:877-998-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12877374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide