Provider Demographics
NPI:1386075521
Name:NKOUAZE, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:NKOUAZE
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 1:6475 NEW HAMPSHIRE AVE STE 504F
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3277
Mailing Address - Country:US
Mailing Address - Phone:301-560-1352
Mailing Address - Fax:301-238-4714
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 504F
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3277
Practice Address - Country:US
Practice Address - Phone:301-560-1352
Practice Address - Fax:301-238-4714
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC00332164X00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164X00000XNursing Service ProvidersLicensed Vocational Nurse