Provider Demographics
NPI:1912244393
Name:TCHOUNGUEN, ODETTE T
Entity type:Individual
Prefix:MRS
First Name:ODETTE
Middle Name:T
Last Name:TCHOUNGUEN
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 1:177 BROWNSFELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7003
Mailing Address - Country:US
Mailing Address - Phone:614-218-0370
Mailing Address - Fax:
Practice Address - Street 1:177 BROWNSFELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-7003
Practice Address - Country:US
Practice Address - Phone:614-218-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 151802-M-I'VE164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700787OtherMEDICAID ID