Provider Demographics
NPI:1902441009
Name:TASSE, JULIETTE GUEMEGNE
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:GUEMEGNE
Last Name:TASSE
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 1:9005 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4211
Mailing Address - Country:US
Mailing Address - Phone:240-898-5170
Mailing Address - Fax:
Practice Address - Street 1:1752 COLUMBIA RD NW STE 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-8837
Practice Address - Country:US
Practice Address - Phone:240-408-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14697374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide