Provider Demographics
NPI:1548518806
Name:NOUTSA, JEPHTE
Entity type:Individual
Prefix:
First Name:JEPHTE
Middle Name:
Last Name:NOUTSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 FAIRLANE PL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2862
Mailing Address - Country:US
Mailing Address - Phone:301-792-8652
Mailing Address - Fax:
Practice Address - Street 1:9223 FAIRLANE PL
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2862
Practice Address - Country:US
Practice Address - Phone:301-792-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide