Individual
IDA MABELLE KONCHOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HHA
Contact information
Practice address
6731 NEW HAMPSHIRE AVE APT 409, TAKOMA PARK, MD 20912-2801
(202) 545-0935
(202) 545-0934
Mailing address
6731 NEW HAMPSHIRE AVE APT 409, TAKOMA PARK, MD 20912-2801
(202) 545-0935
(202) 545-0934
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R207705
MD
Other
Enumeration date
06/15/2012
Last updated
03/20/2020
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