Provider Demographics
NPI:1588318687
Name:NANA NOUNKEU, MIREILLE
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:NANA NOUNKEU
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 1:11200 LOCKWOOD DR APT 1511
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4544
Mailing Address - Country:US
Mailing Address - Phone:202-403-7557
Mailing Address - Fax:
Practice Address - Street 1:11200 LOCKWOOD DR APT 1511
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4544
Practice Address - Country:US
Practice Address - Phone:202-403-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide