Basic Information
| Provider Information | |||||||||
| NPI: | 1457844698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISSE | ||||||||
| FirstName: | DJENABOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1917 BLADENSBURG RD NE # 419 | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200021811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012223185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2652 MARTIN LUTHER KING JR AVE SE APT B9 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | HHA13700 | Y | Nursing Service Related Providers | Home Health Aide |
ID Information
| ID | Type | State | Issuer | Description | HHA13700 | 01 | DC | HOME HEALTH AIDE | OTHER |