Provider Demographics
NPI:1730779679
Name:MBEUNTCHA, PASCALINE TEKEU
Entity type:Individual
Prefix:
First Name:PASCALINE
Middle Name:TEKEU
Last Name:MBEUNTCHA
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 1:902 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5938
Mailing Address - Country:US
Mailing Address - Phone:301-728-0665
Mailing Address - Fax:
Practice Address - Street 1:902 CONLEY RD
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5938
Practice Address - Country:US
Practice Address - Phone:301-728-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000811429374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide