Provider Demographics
NPI:1992168868
Name:KONGNE EPSE CHOMNOU, IRENE LAURE
Entity type:Individual
Prefix:
First Name:IRENE LAURE
Middle Name:
Last Name:KONGNE EPSE CHOMNOU
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 1:11546 LOCKWOOD DR APT C2
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2427
Mailing Address - Country:US
Mailing Address - Phone:301-793-4162
Mailing Address - Fax:
Practice Address - Street 1:11546 LOCKWOOD DR APT C2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2427
Practice Address - Country:US
Practice Address - Phone:301-793-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHHA11938374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide