Provider Demographics
NPI:1588163901
Name:DJEUKAM, ALBERTINE MILOR
Entity type:Individual
Prefix:
First Name:ALBERTINE
Middle Name:MILOR
Last Name:DJEUKAM
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 1:3521 OTIS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-2158
Mailing Address - Country:US
Mailing Address - Phone:240-825-8938
Mailing Address - Fax:
Practice Address - Street 1:3521 OTIS ST APT 1
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-2158
Practice Address - Country:US
Practice Address - Phone:240-825-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13485374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13485Medicaid