Provider Demographics
NPI:1396176467
Name:KOUCHOU, FLORENCE NANA
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:NANA
Last Name:KOUCHOU
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 1:1814 GREENWICH WOOD DR APT 23
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2123
Mailing Address - Country:US
Mailing Address - Phone:240-552-2880
Mailing Address - Fax:
Practice Address - Street 1:1814 GREENWICH WOOD DR APT 23
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2123
Practice Address - Country:US
Practice Address - Phone:240-552-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8969171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA8969Medicaid