Provider Demographics
NPI:1487915286
Name:NOUBISSIE, VERONIQUE TAYOU KAMEGNE
Entity type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:TAYOU KAMEGNE
Last Name:NOUBISSIE
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 1:12342 MANCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5176
Mailing Address - Country:US
Mailing Address - Phone:240-491-1386
Mailing Address - Fax:
Practice Address - Street 1:12342 MANCHESTER WAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5176
Practice Address - Country:US
Practice Address - Phone:240-491-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide