Provider Demographics
NPI:1861756587
Name:ENDJIEU, ROSELINE
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:ENDJIEU
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 1:3405 CLAIRE DR
Mailing Address - Street 2:APT204
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2508
Mailing Address - Country:US
Mailing Address - Phone:240-392-5763
Mailing Address - Fax:
Practice Address - Street 1:3405 CLAIRE DR
Practice Address - Street 2:APT204
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2508
Practice Address - Country:US
Practice Address - Phone:240-392-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5301989374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide