Provider Demographics
NPI:1033472410
Name:MOGOU, SIMONE L
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:L
Last Name:MOGOU
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 1:843 BERKSHIRE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3255
Mailing Address - Country:US
Mailing Address - Phone:301-357-4430
Mailing Address - Fax:
Practice Address - Street 1:843 BERKSHIRE DR APT 8
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3255
Practice Address - Country:US
Practice Address - Phone:301-357-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide