Basic Information
Provider Information
NPI: 1720410079
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TCHUEMBUE
FirstName: MARTINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: HHA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3601 RANDOLPH RD
Address2:  
City: SILVER SPRING
State: MD
PostalCode: 209021046
CountryCode: US
TelephoneNumber: 2025450935
FaxNumber: 2025450176
Practice Location
Address1: 3601 RANDOLPH RD
Address2:  
City: SILVER SPRING
State: MD
PostalCode: 209021046
CountryCode: US
TelephoneNumber: 2025450935
FaxNumber: 2025450176
Other Information
ProviderEnumerationDate: 08/08/2013
LastUpdateDate: 08/08/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374U00000X  Y Nursing Service Related ProvidersHome Health Aide 

No ID Information.


Home