Provider Demographics
NPI:1144573346
Name:DOSSOU, JEANNE ABLA
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ABLA
Last Name:DOSSOU
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 1:6475 NEW HAMPSHIRE AVE STE 504F
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3277
Mailing Address - Country:US
Mailing Address - Phone:301-560-1352
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 504F
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3277
Practice Address - Country:US
Practice Address - Phone:301-560-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200531163W00000X, 363LP0808X
DC90354164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse