Provider Demographics
NPI:1144994971
Name:OMOKOLO EKONO, EDWIGE VICTOIRE (HHA)
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:VICTOIRE
Last Name:OMOKOLO EKONO
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EDGEWOOD ST NE APT 609
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3359
Mailing Address - Country:US
Mailing Address - Phone:240-423-7326
Mailing Address - Fax:
Practice Address - Street 1:601 EDGEWOOD ST NE APT 609
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3359
Practice Address - Country:US
Practice Address - Phone:240-423-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HHA15641251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health