Provider Demographics
NPI:1346049962
Name:KENOU, KOSSIVI IVLABUE
Entity type:Individual
Prefix:
First Name:KOSSIVI
Middle Name:IVLABUE
Last Name:KENOU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3512
Mailing Address - Country:US
Mailing Address - Phone:240-423-9341
Mailing Address - Fax:240-423-9341
Practice Address - Street 1:6209 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3512
Practice Address - Country:US
Practice Address - Phone:240-423-9341
Practice Address - Fax:240-423-9341
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004673374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty